CMS Correcting Errors to Updated Coverage Policy for Genetic Tests


ASCO has confirmed that CMS is currently working to correct technical errors that occurred when they recently updated national coverage policies regarding certain genetic tests. CMS confirms that steps are being taken to reprocess claims that have been denied.


According to CMS, the errors occurred during the mapping process from ICD-9 to ICD-10. During the conversion, certain genetic tests were inadvertently left out of the July update including cytogenetic tests as well as a number of others. Specifically, Part A and Part B claims have been denied relative to NCD 190.3 cytogenetic test. A list of affected codes is available.


According to CMS, Medicare Advisory Contractors (MACs) have temporarily suspended the updates that would cause these claims to be denied. In addition, CMS assures ASCO that affected claims will automatically be re-processed in the near future. Providers need not take any action at this time.


ASCO will continue to monitor the issue and will update members when MACs receive final instruction from CMS and the matter is resolved. Members should inform ASCO if there are any issues that impede delivery of care to their patients.

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