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- CAP Argues LCD Limits Physician Decision-Making and Imposes Dangerous Scope of Practice Restrictions
The CAP recently met with Medicare Administrative Contractor (MAC) Palmetto GBA, a company that handles Medicare claims for the Centers for Medicare & Medicaid Services (CMS), and expressed deep concerns that the MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma Local Coverage Determination (LCD) improperly limits the scope and defines the practice of medicine by board-certified pathologists, licensed physicians and surgeons, who are eligible to order laboratory tests.
In a March 1 letter to CMS and Palmetto, the CAP requested that the subspecialty requirement in the LCD – that any molecular test approved for coverage under the LCD be ordered by a board-certified or board-eligible dermatopathologist – be removed from the coverage policy. The CAP stated further that
imposing restrictions, as a condition of coverage, as to the subspecialty qualifications of those who can order certain tests exceeds the scope of authority of a MAC and contravenes state and federal laws that govern physician scope of practice and prohibits interference in the practice of medicine.
In a July follow-up letter to CMS, the CAP again requested that the subspecialty requirement in the LCD be removed from the coverage policy and that CMS work with its MACs to ensure local coverage policies do not violate federal regulations by limiting the scope of practice of board-certified pathologists or any other licensed physicians and surgeons who are eligible under state licensure laws to order laboratory and molecular tests required for the care and treatment of their patients.
The CAP will keep members informed of any updates to the LCD in the future.