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- State Pathology Societies and CAP Seek to Expand Coverage of Palmetto’s Policies on Special Stains
State Pathology Societies and the CAP called on the Medicare Administrative Contractor (MAC) Palmetto to remove certain coverage limitations to its special stains Local Coverage Determination (LCD). The CAP has long opposed Palmetto’s policies on special stains and has collaborated with state pathology societies in Palmetto’s jurisdiction in an effort to make necessary changes supported by medical evidence.
In December 2021, the CAP sent a formal appeal to Palmetto with proposed revisions to the local coverage determination (LDC) that denies Medicare coverage of special histochemical stains, and immunohistochemical stains and/or special stains for breast, gastrointestinal, and prostate tests under the current LCD.
On July 17, Palmetto hosted a virtual public meeting in designated jurisdictions to discuss the proposed revisions. Pathology Contractor Advisory Committee members representing pathology state societies from Georgia, North Carolina, South Carolina, and West Virginia provided comments on the clinical necessity of IHC and special stains for breast and GI cancers. They also voiced their support for the CAP’s formal comment letter submitted to Palmetto on July 17 that urged further clarification and encouraged expanded coverage including Ki-67, special stains and IHC for prostate, and MMR/MSI testing. State pathology societies also made compelling arguments at the public meeting on the necessity for expanding coverage for prostate stains.
The CAP will continue to advocate through formal comment letters and support from state pathology society contractor advisory committee representatives.