New LCD expanding coverage for prostate cancer patients

May 25, 2022

LUGPA is pleased to inform the membership that Palmetto’s MolDX has finalized a new Local Coverage Determination (LCD) governing “Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer”. The LCD (L38966) and coding article (A58652) is scheduled to become effective on July 3, 2022, when the prior LCD (L36082), which restricted access to testing, will be retired.  

This is an important victory for our prostate cancer patients, literally tens of thousands of whom reside in MAC regions which generally follow MolDx guidance in determining coverage.  We are grateful to MolDx for their recognition of the value that these tests provide, both in counseling and treatment guidance for our individual patients and, in some cases, as possible education and screening opportunities for related family members.  MolDx  has demonstrated acumen in this evolving milieu by outlining  recommendations which accord to NCCN guidelines, thereby expanding the list of genes eligible for coverage well beyond the very limited panel previously specified for coverage (BRCA1/BRCA2/+/-PALB2). A worksheet detailing additional coverage details is available here. More than half of the Medicare Administrative Contractors in the United States adopt MolDx recommendations, and we can anticipate modification of their LCDs to reflect the updated guidance.  

LUGPA applauds MolDx for taking the lead nationally on this issue and sincerely thank our Health Policy Committee, legal counsel, advisors, and coalition of aligned stakeholders whose collaborative efforts made this possible.