Liquid Biopsy - Medicare Advantage

This Humana Medicare Advantage coverage article follows CMS NCDs/LCDs/LCAs and MolDX criteria to determine coverage of liquid biopsy MDTs and LDTs. Specific tests (FoundationOne Liquid CDx, Guardant360 CDx, Resolution ctDx FIRST, InVisionFirst-Lung, Resolution ctDx Lung, and circulating tumor cell tests) are covered only when the listed test-specific criteria (including meeting NCD 90.2 where applicable, MoIDX approval or FDA labeling, tissue infeasibility, or LCD criteria) and documentation requirements are met; several tests (eg, CellSearch CMMC, CellSearch HER2 CTC, LungLB, DEPArray HER2) are explicitly not considered medically reasonable and necessary.

"Humana and subsidiaries provide coverage for MDTs and LDTs identified as covered in an NCD, LCD or LCA when medical necessity criteria are met; however, for jurisdictions with no Medicare guidance ..."

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