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December 2020

CMS approves Next Generation Sequencing for certain cancer patients

The Centers for Medicare & Medicaid Services has determined that Next Generation Sequencing is covered as a diagnostic laboratory test for patients with germline (inherited) ovarian or breast cancer when:

  • It’s performed in a Clinical Laboratory Improvement Amendments, or CLIA, certified laboratory.
  • It’s ordered by a treating physician.
  • Specific requirements are met.

The CMS decision is retroactive to Jan. 27, 2020, and affects all Medicare Advantage plans, including Medicare Plus Blue℠ and BCN Advantage℠.  The implementation date for claims processing was Nov. 13, 2020.

Next Generation Sequencing is a technique that can measure one or more genetic variations as a laboratory diagnostic test, such as when used in conjunction with an in vitro diagnostic test.

The decision memo** about this topic is available on the CMS website.

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