UnitedHealthcare Expands Multiple Genetic and Molecular Policies
UnitedHealthcare (UHC) Community Plan’s August policy update revised several medical policies to reflect phase 2 of the DEX® Z-Code requirement for...
1 min read
On May 29, Medicare announced it would expand coverage for genomic sequence analysis panels in the treatment of hematolymphoid diseases.
The local coverage determination (LCD) “provides limited coverage for genomic sequence analysis panels under specific clinical circumstances.” Specifically, these multi-gene panel tests would be used for diagnosis, risk stratification, and treatment planning for patients with hematolymphoid diseases, including newly diagnosed or relapsed/refractory acute myelogenous leukemia, myelodysplastic syndromes with nondiagnostic assessments, and myeloproliferative neoplasms requiring risk stratification or disease monitoring.
The College of American Pathologists applauded the proposed updates in a 2024 letter, expressing support for the decision to broaden coverage. According to CAP, the policy aligns with the National Comprehensive Cancer Network guidelines and the World Health Organization classifications.
The revision is effective for services performed on or after July 13, 2025.
Sources:
https://www.cap.org/advocacy/latest-news-and-practice-data/june-10-2025#story5
CMS Launches IDR Gateway: What Providers Need to Know Before September 15
In late 2026, the Federal Independent Dispute Resolution (IDR) process will transition from single-use web forms to the new IDR Gateway, which will...
Organizations Representing Clinical Labs and Diagnostics Write in Support of Legislation to Improve Medicare LCD Process
A coalition of more than 30 stakeholder organizations has written to key lawmakers expressing their support for the Timely Access to Coverage...