Tuesday, June 6, 2023

Novitas/FCSO: To Hold Webinar and Explain Confusing Oncology LCD

See the LCD

On June 2, 2023, First Coast and Novitas MACs released a massive oncology genomic testing LCD - about 40,000 words and circa 70-90 pages when printed.  My blog and links here.  Genomeweb here.

Watch the Webinar!

The MACs will hold webinars to "explain the LCD," on Wednesday June 21 and Thursday June 29, the first at 3-430 ET and the second at 12-130 ET.

Find the web page with registration and a chance to submit written questions:


I'll cut and paste the full text below.  Check the web site above to register or see updates.  They note the language of the webinar is English, which may reassure some skeptics who wondered whether the original complex. challenging to absorb, and multifaceted LCD was written in what language.  The webinar materials include the several-hundred-page LCA or billing article. 



"New Local Coverage Determination (LCD): 

Genetic Testing for Oncology" (Part A/B)

A Novitas and First Coast collaborative event

Delivery language: English

With advancement in science and technology comes the ability to incorporate genetic testing for oncology biomarkers into clinical care, with the goal of improved patient outcomes. 
A new local coverage determination (LCD) has been created to provide the coverage criteria and limitations, effective July 16. The scope of this LCD is DNA and RNA genetic testing in the practice of oncology in the Medicare population.
This multi-contractor collaborative session will include an overview of the new LCD: Genetic Testing for Oncology. We'll highlight the coverage indications and limitations within the LCD and review utilization parameters and documentation requirements within the companion local coverage article (LCA), while also:
 Reviewing the integral components of the LCD
 Determining the purpose of the LCA
 Examining the LCA to discover the CPT and ICD-10 coding guidelines
Target Audience: This webcast is intended for any oncology-focused providers, ordering providers and laboratories who perform, order or bill for these services, as well as their coding and billing staff.
Click on ‘Register now’ and follow the instructions.

Wednesday, June 21

3-4:30 p.m. ET

Thursday, June 29

12-1:30 p.m. ET

We offer continuing education credits, click here for more information. Also, want to submit questions prior to this event? Email us at elearning@fcso.com no later than Friday, June 16..  


This is my table of the LCD organization.   In the Introduction, they mention their interest in Knowledge Databases, such as NCCN Biomarkers.  Then, they discussed these in "covered indications," for 6 pages.  Then they discuss these databases in the Evidence section for 7 pages, and in the Analysis section for 9 pages.   Overall, about 21% of the text (by word count) is about these knowledge databases.  See below:

click to enlarge

Evidence versus Analysis - the CMS LCD Template

About 12% of the document is a reporting of text-specific data (e.g. evidence) and about 38% of the document (by word count is test-specific analysis or judgement.   For example, "Test A was validated in 100 patients with 80% accuracy" is the Evidence section.  They might return to the same study again in the Analysis section, but this time saying, "80% accuracy is not good enough for Medicare coverage.50% of the document text (12% + 38%) is test-specific for about a dozen proprietary branded tests.