Expanded Medicare coverage of NGS tests for certain cancers approved

CMS is expanding Medicare coverage of next-generation sequencing (NGS) to diagnose certain types of ovarian and breast cancer, according to a January 27 decision memo.

The decision memo expands national coverage of NGS when the follow conditions are met:

• The test is ordered by a treating physician and performed in a Clinical Laboratory Improvement Amendments-certified laboratory
• The patient has inherited ovarian or breast cancer and has not previously been tested using NGS

In addition, Medicare Administrative Contractors (MAC) will be allowed to determine whether to cover NGS for other types of cancers.

The decision memo builds on a March 2018 national coverage determination that provided coverage for NGS for certain relapsed or advanced cancers.

Organizations interested in offering NGS to this newly covered patient population should review and adapt policies for ordering NGS tests. Ensure that clinical staff, as well as coding and billing staff, are aware of the changes. Organizations considering offering NGS tests for other types of cancer may consider contacting their MAC for more information.