Medicare's NCD 90.2, NGS in Cancer, provides automatic coverage for FDA-approved NGS companion diagnostics.
In Transmittal R12626, CMS endorses coverage as follows:
- 0448U, OncoReveal, Pillar biosciences, for CRC and NSCLC, effective April 1, 2024.
- 0473U, xT CDx (Tempus AI), for CRC and all solid cancers, effective July 1, 2024. ("Use 81479 April 28, 2023-June 30, 2024").
CMS adds new PLA codes 0450U to 0475U effective July 1, 2024:
https://www.cms.gov/files/document/r12606cp.pdf
CMS also issued updates to its correct coding instructions (NCCI):
Modifying in part the use of MOD 59 plus XE XP XS XU:
