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- Pathologists press for Medicare coverage reforms
CAP leaders met with staff from Rep. Nanette Barragán’s (D-CA) office to show how current Medicare coverage policies affect patient care.
What we're saying: The conversation focused on building support for legislation that would require increased transparency for and timely review of of local coverage determination (LCD) requests in Medicare.
- Mary D. Le, MD, FCAP, described a current LCD that limits the ordering of certain molecular tests to dermatopathologists, and how this can delay or block needed care.
- Eric F. Glassy, MD, FCAP, highlighted the central role pathologists play in diagnosis and why clear, consistent LCDs are essential for patients.
- He pointed to Ki-67, a commonly used and relatively low-cost test for breast cancer, noting that some LCDs prohibit ordering it even though it’s critical for assessing how quickly a tumor is growing.
The impact: Delayed or restrictive LCD decisions can prevent patients from receiving appropriate molecular and biomarker testing, undermining accurate diagnosis and treatment planning.
What’s next: The CAP will keep pushing for Medicare coverage reforms and will share future opportunities for members to add their voices and support advocacy efforts.