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Policy Category: Reimbursement

PMC advises Medicare and Medicaid officials on reimbursement policies that can help ensure sustainable patient access to personalized medicine. In 2020, for example, PMC began advocating for increased Medicare payment rates for hospitals that provide chimeric antigen receptor T-cell therapies, a potentially life-saving class of personalized cancer treatments. PMC’s recommended payment solution is still in place today.

CMS’ Proposal to Discontinue the Use of ICD-10 NOS Reimbursement Codes

CMS’ Telehealth Policies

CMS’ Clinical Laboratory Fee Schedule

National Government Services’ Proposed Local Coverage Determination on Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

CMS’ Proposal for an Innovative Technology (MCIT) Pathway for Breakthrough Devices and Definition of ‘Reasonable and Necessary’

Drug Pricing Policies in the United States

CMS’ Coverage of Blood-Based Screening Tests in Colorectal Cancer

PalmettoGBA’s Proposed Local Coverage Determination for Minimal Residual Disease Testing for Cancer

CMS’ Proposed Changes to ‘Laboratory Date of Service Policy’

CMS’ Oncology Care Model

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