The CMS agreed to retain over 100 diagnostic (ICD-10) codes that they proposed to remove from the Next Generation Sequencing (NGS) national coverage determination by July 1. Additionally, the Florida Medicare Administrative Contractor (MAC) proposes to retire its local coverage policy for special stains.

CMS Keeps Over 100 ICD-10 Codes

The CAP has applauded the CMS for keeping over 100 diagnostic codes in its NGS national coverage determination. In April the CAP and over 30 other medical laboratory health organizations asked the CMS not to remove the diagnostic codes from the national coverage determination for NGS as it would have resulted in non-coverage of genomic testing for many patients with advanced cancer and thousands of denied Medicare Part B claims. This is a significant victory for patients, pathologists, and other providers who rely on the tests.

Florida MAC Retires LCD

First Coast Service Options, the Medicare Administrative Contractor (MAC) for Florida, is proposing to retire its Special Histochemical Stains & Immunohistochemical Stains local coverage determination (LCD) and is accepting comments until July 23rd. The First Coast Service Options stated it wants to retire its Special Histochemical Stains & Immunohistochemical Stains LCD because “a review of the current literature revealed that the LCD and its corresponding Billing and Coding Article are neither reflective of the current standard of practice, nor having a significant impact on Medicare expenditures.” The CAP worked in concert with its Contractor Advisory Committee (CAC) representatives and other pathologists at the local level to oppose this coverage policy when it was first proposed and implemented in 2015. The CAP welcomes this recent development, and the CAP will again engage regarding this policy during the current comment period supporting the proposed retirement of the policy.