Navigate Shifting Reimbursement Criteria for Molecular Testing
At TELCOR, we’ve recently identified a notable shift in how molecular claims specifically associated with CPT code 87798, are being processed by...
1 min read
The U.S. House of Representatives Committee on Energy and Commerce held a hearing Thursday to discuss legislation related to breakthrough medical technology access and Medicare local coverage determinations.
Bills discussed during the hearing included the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act (H.R. 842) and a bill “to amend title XVIII of the Social Security Act to ensure transparency in the national coverage determination (NCD) process under the Medicare program and to make certain adjustments to Medicare local coverage determinations (LCDs).”
According to the hearing memo, H.R. 842 “would allow for Medicare coverage of, and payment for, [U.S. Food and Drug Administration] cleared or approved multi-cancer early detection … screening tests.”
Additionally, the legislation intended to ensure transparency in the national coverage determination process for Medicare “would require the [U.S. Department of Health and Human Services] Secretary to determine whether a request for an NCD is complete within 90 days of receiving the request … and would direct the Secretary to require that [Medicare Administrative Contractors] not develop any LCDs that conflict with any law, regulation, NCD, payment policy, or coding policy.”
“These policies are essential to reducing regulatory barriers to help patients get access to care, while also bringing more transparency into the coverage process,” Rep. Morgan Griffith (R-Va.), chairman for the subcommittee on health, said in his opening statement.
Sources:
https://d1dth6e84htgma.cloudfront.net/09_18_2025_HE_Hearing_Memorandum_c5b0d72f9b.pdf
Quality Payment Program Claim Adjustment Applied to Correct Conversion Factor
The Centers for Medicare & Medicaid Services has found a system issue related to the 2026 Medicare Physician Fee Schedule conversion factors.
Updated CDLT Data Reporting Period to Begin May 1
Effective May 1, clinical diagnostic laboratories will be required to follow new data reporting requirements for clinical diagnostic laboratory tests...