Monday, September 25, 2023

Unprecedented CMS Press Release Insists No Change in a MAC LCD Policy (Transplants)

Close readers of the Wall Street Journal will have noted three articles in the past week on coverage for molecular transplant-monitoring tests (such molecular tests are offered, in different forms, by CareDx, Natera, and Transplant Genomics, perhaps others).

These articles included an Op Ed, and a Letter, and a second Op Ed on the heels of the first one.  

  • September 10, Op Ed, "Medicare's Bad Call on Transplants," here.
  • September 17, Letter, "Medicare is Penny Wise, Pound Foolish," here.
  • September 22, Op Ed again, "Medicare's Organ Transplant Face Plant," here.
    • Some of this covered June 27 at Genomeweb, Forest Ray, here.
While MolDx does not generally (or ever?) directly comment on newspaper articles, CMS has issued a national press release on the topic today, September 25.

The press releases is 7 paragraphs long but packages the main information in the first paragraph, here:

The Centers for Medicare & Medicaid Services (CMS) confirms that neither CMS nor the Medicare Administrative Contractors (MACs) have made changes that affect patients’ ability to have blood tests used to monitor for organ transplantation rejection covered when ordered by their physicians in medically appropriate circumstances. Patients with transplanted hearts, lungs, or kidneys who meet the coverage criteria for these tests, as laid out in the Local Coverage Determination (LCD), can continue to access these tests in place of a more invasive biopsy.

See the link above for the full CMS response. 


AI Corner 1:

I asked Chat GPT to read the WSJ op eds, read the CMS press release, and then discuss, compare, contrast.

AI Corner 2:

Chat GPT summarizes the 540 word press release in 90 words.  Less impressive to the eye this time, in that CMS basically made its own 90-word summary in its own first paragraph.

The Centers for Medicare & Medicaid Services (CMS) confirms no changes in the coverage policy for blood tests used for monitoring organ transplantation rejection. The tests remain covered for heart, lung, or kidney transplant patients meeting specific criteria, offering a less invasive alternative to biopsy. Despite concerns over improper billing and overutilization, and subsequent revisions to billing instructions, the core coverage remains unchanged. A new proposed Local Coverage Determination (LCD), released for public comment, maintains existing coverage criteria, ensuring continued patient access to these essential tests when ordered by physicians.

And the Chat GPT haiku:

Tests still covered well
Transplants monitored with care
Biopsy spared now.