Medicare administrative contractors (MACs) that participate in Palmetto’s molecular diagnostic services (MolDx) program have finalized coverage policies for the PreciseType human erythrocyte antigen (HEA) test from Immucor Inc, Norcross, Ga.
The FDA-approved molecular diagnostic evaluates blood compatibility between donors and patients to help prevent mismatches that can cause life-threatening reactions.
Noridian Healthcare Solutions, a MAC that covers Medicare Part B in 14 states north and west of Colorado, has finalized its local coverage determination (LCD), following the precedent set by Palmetto GBA and CGH administrators last year.
LCDs give providers coverage guidance and enable them to code claims accurately for specified classes of Medicare patients who can benefit from better-matched blood. These include Medicare patients with conditions that result in anemia for which frequent transfusions may be required, including those undergoing treatment for diseases such as sickle cell anemia and thalassemia.
“The PreciseType HEA test is the only molecular immunohematology test to have successfully completed the MolDx technical assessment, a process that involves demonstrating the test’s analytical and clinical validity to subject matter experts, among other requirements,” says Joel de Jesus, senior director of government affairs and payor relations at Immucor.
According to Keith Chaitoff, chief marketing officer at Immucor, the coverage determination is especially timely. “This coverage determination becomes particularly important for patients and providers given the recent AABB bulletin advising that patients receive a baseline phenotype or genotype test before initiating treatment with one of the new class of monoclonal-antibody-based therapeutics for cancer recently approved by FDA,” he says. According to AABB, a US-based international association for transfusion medicine, the new therapeutic agents can result in interference with blood bank serologic tests and thereby cause delays in issuing red blood cell units to patients receiving these agents.
Beyond the MolDx program, additional coverage for the PreciseType HEA test became effective in Alabama, Georgia, and Tennessee on April 1, when Cahaba released its LCD.
MACs have provided approximately 55 classification of diseases (ICD-10) codes that support medical necessity for their beneficiaries.
For more information, visit Immucor.