Diagnostic Tests Coding, Coverage, and Payment
AdvaMed develops and advocates for sound payment policies that promote equitable patient access to diagnostic tests.
The AdvaMed Payment & Health Care Delivery Policy Team develops and advocates for sound payment policies that promote equitable patient access to diagnostic tests. Working to addresses both short and long-term issues relevant to coding, coverage, and payment for diagnostic tests, our team weighs in on important regulatory, legislative, and private payer policies impacting the diagnostic testing members through consistent and proactive engagement with elected officials and Agency leaders. Our team collaborates with physician specialty societies, laboratory and hospital associations, and other key stakeholders to achieve our common goals.
Key Areas of Focus
Coding
- Advise on and review new Current Procedural Terminology (CPT) code applications for pathology and diagnostic services
- Work to address problematic changes to the National Correct Coding Initiative (NCCI) edits
- Monitor and weigh in on changes to coding policies relevant to diagnostic tests
Coverage
- Further and advocate for policies that streamline coverage of new and innovative diagnostic tests under Medicare
- Address issues surrounding insurers’ prior authorization programs
- Monitor and weigh in on Medicare coverage determinations
- Support ways to modernize Medicare coverage for preventative services
Payment
- Advocate for legislation that works to improve the rate-setting under the Protecting Services to Medicare Act (PAMA)
- Develop and promote payment reform that improves rate-setting methodologies for new tests
- Explore use of diagnostic tests in Alternative Payment Models
AdvaMedDx
Our team supports the mission and objectives of AdvaMedDx, a division of AdvaMed. AdvaMedDx represents over 70 manufacturers of innovative in vitro diagnostic (IVD) tests in the U.S. and abroad. AdvaMedDx seeks to advance policy to promote innovation and expand access to quality testing.
