Medicare claims for genetic cancer tests face growing rejection rates

Medicare claims for genetic cancer tests face growing rejection rates

Both the use of next-generation sequencing (NGS) testing for cancer and the rate of claim denials for such testing increased between 2016 and 2021, despite implementation of a recent Medicare national coverage determination that established coverage standards for NGS testing.

Increase in Claim Denials for Cancer-Related Advanced Genetic Testing

A recent comprehensive study conducted by researchers at Georgetown University has unveiled a paradoxical trend in the utilization and reimbursement landscape of next-generation sequencing (NGS) for cancer patients under Medicare. Despite the establishment of a national coverage determination (NCD) aimed at standardizing and clarifying reimbursement policies for NGS tests, the use of this advanced genomic testing has surged significantly between…