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CMS votes unanimously to maintain Medicare's reimbursement rate for Cologuard CRC screening test
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The CMS Advisory Panel on Clinical Diagnostic Laboratory Tests voted unanimously (11-0) to maintain Medicare’s current reimbursement rate of $492.72 for the Cologuard stool DNA screening test for colorectal cancer, Exact Sciences announced.
The vote follows a proposal presented by Kevin Conroy, chairman and CEO of Exact Sciences, at the Clinical Lab Fee Schedule’s public meeting on July 16th, to crosswalk Cologuard from its G-code to a CPT code, according to a press release.
“We’re very pleased with the panel’s unanimous vote in favor of maintaining the current Medicare reimbursement for rate for Cologuard,” Conroy said in a press release. “CMS will post a preliminary determination after considering the July meeting comments, today’s panel vote, and other written comments. A final determination is expected to be released in the November timeframe and will be effective January 1, 2016.”
According to the release, this was the first meeting for the new Advisory Panel on Clinical Diagnostic Laboratory Tests, established by the 2014 Protecting Access to Medicare Act, “which directs the Secretary of Health and Human Services to consult with an expert outside advisory panel on establishing payment rates for new clinical diagnostic laboratory tests, including whether to use crosswalking or gapfilling processes to determine payment for new clinical laboratory test and the factors used in determining coverage and payment processes for new clinical diagnostic laboratory tests.” The act requires the secretary to establish the panel, and requires the panel to be composed of individuals with appropriate expertise, including clinical laboratory representatives and researchers, molecular pathologists, and clinical laboratory science or health economics experts, the release said.