Revised Medicare Diagnostics Coverage Policies Incorporate IDSA Recommendations

Medicare Administrative Contractors First Coast and Novitas Solutions, whose jurisdictions cover 12 states, Puerto Rico, the U.S. Virgin Islands and the District of Columbia, have finalized identical payment policies for Gastrointestinal Pathogen Panels Utilizing Multiplex Nucleic Acid Amplification Techniques, effective Dec. 30. The final policies were released following a public stakeholder comment period and include IDSA recommendations.

In September, IDSA, the American Gastroenterological Association, American Society for Microbiology, Association for Molecular Pathology, Association of Public Health Laboratories, College of American Pathologists, and Pan American Society for Clinical Virology submitted joint comments detailing concerns about aspects of the proposed coverage indications, limitations, and summary of the evidence outlined in the draft policy that did not appropriately align with current clinical practice.

The final policies reflected several of our societies’ recommendations and repeatedly referenced IDSA guidelines. Recommendations that were considered and incorporated include:

• Expanded coverage for chronic diarrhea and abdominal symptoms when medically reasonable and necessary, based on the 2017 IDSA guidelines for the diagnosis and management of infectious diarrhea;
• The addition of paralytic ileus, severe and persistent abdominal pain with fever, and nausea and vomiting 24 hours or less to coverage indications/limitations in alignment with Table 3 of the 2017 guidelines; and
• Affirmative clarification of coverage for stepwise testing utilizing smaller panels on the same date of service and repeat testing of beneficiaries negative by GIP panel within seven days during the same episode.

These additions and clarifications will have direct positive impacts for patients, and IDSA will continue to advocate for appropriate reimbursement for critical infectious diseases diagnostic tests.