Palmetto Finalizes Medicare Coverage for MRD Cancer Testing
December 6, 2021Medicare Administrative Contractor Palmetto GBA released on Thursday a finalized local coverage decision for minimal residual disease cancer testing.
The general decision could cover MRD tests from a variety of companies, including Natera, NeoGenomics, Exact Sciences, Invitae, and Guardant Health, as long as those tests meet the coverage criteria.
Under the future LCD, which goes into effect Dec. 26, tests must be used to noninvasively monitor minimal residual disease; patients must have a personal history of cancer where the type and staging are within the intended use of the test; and identification and monitoring of recurrence must be identified in National Comprehensive Cancer Network or other established guidelines as a condition that would require a definitive change in treatment management..
If a test uses next-generation sequencing, criteria under the national coverage determination for NGS must be met, unless they’re not applicable — namely, the patient must have advanced cancer, plan on being treated for said cancer, and hasn’t been previously tested with the same test for the same genetic content.