decisionhealth Newsletters, Part B News - 2020 Issue 2 (February)
One genomic testing code skyrockets, another fluctuates, but denials remain lofty
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Article Overview
This article examines recent Medicare claims data for next-generation sequencing-related genomic testing services, focusing on utilization, payment trends, and denial patterns over a three-year period. It is relevant to coders, billing staff, compliance teams, and clinical practices working with molecular pathology and oncology testing policies. The discussion is centered on broad coverage and claims-adjudication trends rather than detailed coding guidance.
Why This Topic Matters
The article highlights how coverage changes and payer policy can affect utilization, reimbursement, and denial rates for genomic testing services, which is important for practices managing molecular pathology billing and compliance.
What You Will Learn
- How Medicare claims activity changed over time for two widely used genomic testing services
- How payment and denial trends can differ across genomic testing scenarios
- Why next-generation sequencing coverage policy is relevant to claims outcomes
- What broad utilization patterns were observed in hereditary cancer and solid tumor testing contexts
Who Should Read This
- Medical coders
- Billing specialists
- Revenue cycle teams
- Compliance professionals
- Molecular pathology practices
- Oncology practices
Codes Discussed
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