Guardant Health Liquid Biopsy Test to be Covered by EviCore

  • May 2, 2019

Guardant Health said today that its Guardant360 liquid biopsy test will be covered by health plans associated with technology assessment firm EviCore beginning this summer. As a result, the test will have become a covered benefit for approximately 150 million people in total. The new decision by EviCore will make the test covered for its health plan members as medically necessary to assist in...

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CMS Reopens Coverage Determination on Next Generation Sequencing for Cancer Patients

  • May 2, 2019

 CMS Monday (4/29/2019) reopened its national coverage determination (NCD) for next-generation sequencing (NGS). The move follows pressure from healthcare organizations that argued the agency's original decision on NGS would prevent Medicare beneficiaries with early-stage cancer from accessing the tests. CMS, in a tracking sheet, said it is reconsidering only the evidence available for...

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Top 12 Artificial Intelligence Innovations Disrupting Healthcare by 2020

  • May 2, 2019

Instead of viewing AI as something still lingering on the distant horizon, this year’s Disruptive Dozen panel was tasked with assessing which AI innovations will be ready to fundamentally alter the delivery of care by 2020 – now less than a year away. Augmenting Diagnostics and Decision-making Artificial intelligence has made especially swift progress in diagnostic specialties, including...

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New Waived Tests - R4277CP

  • May 2, 2019

Table 1: New Waived Tests Requiring QW Modifier CPT Code Effective Date Description 80305QW September 14, 2018 Walmart Stores, Confirm Biosciences Equate Multi-Drug of Abuse Test Cup 87880QW October 26, 2018 BD Diagnostic Systems, BD Veritor System 89300QW November 28, 2018 BonrayBio LensHooke X1 Semen Quality Analyzer...

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Interpace Diagnostics Receives Approval to Launch Thyroid Test in New York

  • May 2, 2019

Interpace Diagnostics announced today that it has received approval from New York State to launch its ThyraMIR diagnostic assay on formalin-fixed, paraffin-embedded tissue samples from thyroid nodules. According to Interpace, its ThyraMIR assay is now the only molecular test approved to be used on indeterminate thyroid nodule samples presented through fine needle aspirates in Asuragen's...

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Claim Rejection and Denials for Providers on the Preclusion List to Begin on April 1, 2019

  • May 2, 2019

Effective April 1, 2019, Medicare Advantage (MA) and Part D plans will begin rejecting or denying claims submitted for payment for Part D drugs and MA services and items prescribed or furnished by an individual or entity on the Preclusion List. This effort supports CMS’ commitment to safeguarding patients and taxpayer funding.

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Vitamin D Testing: Comparative Billing Report in April

  • May 2, 2019

CMS will issue a Comparative Billing Report (CBR) on vitamin D testing in April, focusing on providers who submit Medicare Part B claims. These reports contain data-driven tables with an explanation of findings that compare your billing and payment patterns to those of your peers in your state and across the nation. CBRs are not publicly available. Look for an email from cbrpepper.noreply@...

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CMS to Test New Models for Medicare, Medicaid Dual Eligibles

  • May 2, 2019

CMS has issued a letter to state Medicaid directors inviting them to test new, integrated care models for individuals dually eligible for Medicare and Medicaid. There are 12 million dual eligible beneficiaries, CMS noted. Many of them have complex medical issues, including multiple chronic conditions. The agency’s approaches include capitated financial alignment models, which create a way to...

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