Molecular Dx Reimbursement: Medicare Contractor Seeks Tighter Controls
This article was originally published in The Gray Sheet
The Medicare contractor that handles claims for California and several other states is taking steps to enhance its control over reimbursement of molecular diagnostic tests.
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Diagnostic industry players support the regional Medicare contractor’s evidence-based reimbursement requirements for molecular diagnostics and are hoping CMS adopts the approach nationally.
In a recent presentation on evidence-based reimbursement and personalized medicine, a Novartis executive highlights Medicare Part B contractor Palmetto GBA’s molecular diagnostic reimbursement initiative as one to watch.
Recent moves by CMS have left up in the air an innovative program that gives labs a clearer opportunity to demonstrate clinical utility and test value. It’s therefore unclear whether companies and their backers should expect any greater certainty over the ability to command premium prices for high-value diagnostic tests.