Thursday, September 17, 2020

Medicare Releases Claims Processing Instructions for New 2020 NCD for Germline NGS in Cancer

Early in 2020, CMS released a major update to its NCD for uses of NGS testing in cancer patients.  The update focused on new rules and coverage for germline risk testing (especially for FDA authorized tests) using NGS - here.

On September 11, 2020, CMS released Transmittal 11837, which provides its MACs with official notice that the new NCD exists and claims processing instructions.

  • See CR11837 here.
  • See Medlearn Matters version here.
Notoriously, in 2018, CMS issued a transmittal about the original NGS NCD which included some new text that changed the meaning of the NCD released earlier in the year.  So far, it doesn't look like any weirdness is going on in CR11837.   

The instructions ask MACs to work together for uniform implementation up to such time as CMS may determine shared (mandatory) implementaiton rules are provided.