Establish Medicare Local Coverage Determinations (LCDs) for molecular diagnostic tests including NGS, setting medical necessity criteria and reimbursement rates.
Key Activities
LCD development; technical assessment of molecular tests; coding and billing guidance; coverage for NGS and liquid biopsy; stakeholder comment process. Also issued a May 2024 clarification on CMS 'treating physician' guidance (addressing 14-Day Rule ambiguity) that clarified pathologists can initiate reflex broad molecular-panel testing without a treating-physician order.