Wednesday, 03 October 2018 09:10

Palmetto Finalizes LCD for Multiplex NAATs for Respiratory Viral Panels

On September 27, 2018, Medicare A/B Contractor Palmetto GBA finalized its draft local coverage determination (LCD) for Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels. This policy limits coverage of multiplex PCR respiratory viral panels to 3-5 pathogens in susceptible populations and takes effect for services performed on or after November 12, 2018.

Clinical and Public Health Microbiology Committee Chair Dr. Melissa Miller participated in the “Palmetto Open Draft Local Coverage Determination (LCD) Meeting” in Charleston, WV in June, 2017 and presented concerns on behalf of ASM.

On July 20, 2017, ASM joined other science societies with expertise in diagnostic testing in two letters addressing the Palmetto Draft Local Coverage Determination of Panels Identified by Multiplex Nucleic Acid Amplification Tests (NAATs). Palmetto's response to public comments can be found here.

In a joint comment letter on May 19, ASM requested that Palmetto allow coverage of the full multiplex panels when they are determined to be clinically warranted, especially in three clinical scenarios - immunocompromised individuals; adult patients with acute respiratory illness (ARI) in outpatient settings; and select patients who are admitted to the intensive care unit.

Recently Dr. Miller spoke with Dr. Paul Gerrard, the new Medical Director of Palmetto GBA and MolDX Director of Clinical Science, on October 8 to inquire about possible options moving forward.

See the full L37713 coverage determination document.