Invitae reports final Medicare pricing for breast cancer related disorders
Invitae Corporation announced that the Centers for Medicare and Medicaid Services announced final pricing for genetic testing for hereditary breast cancer-related disorders. The tests are billed under the new current procedure terminology code 81432, which became effective on January 1, 2016. CMS had previously announced a temporary payment per test of $622.53, and -- after a public comment period -- the final payment per test is now set at $925. Payments are made by Noridian, CMS's administrative contractor for California. The payments reflect a decision by the Palmetto MolDX program, the Medicare contractor that determines molecular testing policy in about 20 states, including California. According to their recently published guidance titled "Next Generation Sequencing and Tier 1 and Tier 2 Coding and Billing Guidelines," CPT code 81432 should be used for tests conducted by next-generation sequencing which include BRCA1, BRCA2, and 12 or more other genes relevant to hereditary breast cancer-related disorders, regardless of whether a single gene or multiple genes are selected for testing. Invitae's test offers detection of single nucleotide variants as well as deletions, duplications, rearrangements, and larger copy number variants all at the same price under a single CPT code.