Friday, January 24, 2025

Going Boldly Where MolDX Has Never Gone Before: DEX Contains LCD Links!

The unique MOLDX program, which sets molecular policy and pricing for about 29 states nationwide, offers an online database (not mirrored at CMS) which shows coverage status of many tests.  They now have unveiled a data window that shows you the relevant Medicare coverage article or LCD for each test.

See the result below: Click to enlarge


Up at the very tippy-top you can see this is the Diagnostics Exchange Registry with Bruce Quinn signed in.  The name of the test is Signatera/CRC/MIBC.   Our database location - in bars near the top - is Catalog/ All Lab Tests/ Keyword Signatera/ Signatera Single Plasma Test / and so on.

The test is then described in three or four sentences. ("This test combines...")

We see the local price (under code 81479 and a Z code) is $2098.45.   NEWLY, we see a box for MCD, Medicare Coverage Database, where the field is "A58476".   Though it's not hotlinked, you can search A58476 at the CMS Medicare Coverage Database.     

At far bottom, we see for plan type = MOLDX, the text is covered.    

WHAT YOU CAN'T DO YET

You can't click on an LCD - such as for minimal residual disease - and see all the tests available under the LCD.

YOU MIGHT STILL BE PUZZLED

In the example above, you can read the long test name, plus the several sentence test description, and refer back to the LCD, and still have a hard time integrating it all together as to for what patient, under what conditions, this test is covered for, or at exactly what timepoint interval, etc.   

ANOTHER THING  YOU CAN DO NOW

If you have the tab catalog horizontal location-bar near the top chosen for "Catalog Overview" and "All Lab Tests," you can see a left side set of choice boxes for general types of tests, which then display in the body of the form.   Click to enlarge:


MolDx might be able to use this html framework for interface except in a new version where instead of test types, the left-side pull down would be an LCD list.