Local Coverage Determinations Roundup
June 13, 2022Medicare Administrative Contractor Palmetto GBA recently released a foundational local coverage determination (LCD) for melanoma risk stratification molecular tests that provides coverage for assays from at least two companies.
The final LCD was released last week and goes into effect on July 3. The LCD provides coverage for molecular melanoma risk stratification tests when the patient has a personal history of melanoma and either stage T1b and above or T1a with documented concern about adequacy of microstaging. The patient must also be undergoing workup or being evaluated for treatment and cannot have metastatic disease. They should also have presumed risk for a positive sentinel lymph node biopsy greater than 5 percent based on clinical, histological, or other information. In addition, the patient must have a disease stage, grade, and Breslow thickness — or other qualifying conditions — within the intended use of the test.