Palmetto Finalizes Positive LCD for Prostate Cancer Risk Tests

Medicare Administrative Contractor Palmetto GBA has finalized a local coverage determination under its MolDX program that would provide coverage, within specific parameters, for the use of molecular biomarkers to add to the risk stratification of patients being screened for prostate cancer.

As a foundational LCD, the coverage is not test brand-specific, but rather outlines coverage for any test that meets its criteria and passes a technology assessment by MolDX. It becomes effective July 3, 2022.

The LCD defines two applications of molecular biomarkers to risk-stratify patients at increased risk for prostate cancer: a non- or minimally invasive test whose results can inform the decision to perform an initial biopsy, or a test that can further refine risk when a biopsy has been performed but the presence or absence of cancer still isn’t clear to pathologists.