The nonprofit Center for Medical Technology Policy’s Green Park Collective, a multistakeholder forum, has released a draft of its initial guidelines for insurance coverage of NGS-based oncology testing. The guidelines recommend coverage of NGS panels of 5–50 genes that include a subset of genes that “are considered to be standard of care and medically necessary for the patient.” These panels should conform to the American Medical Association’s Current Procedural Terminology codes 81445 or 81450. Whole-exome and whole-genome sequencing are not recommended for coverage. The draft guidelines also recommend that to confirm analytical validity payers use the College of American Pathologists’ NGS accreditation program and proficiency testing. Guideline proposals include recommendations for coverage of panels of more than 50 genes with preauthorization and under “circumstances of extenuating medical need,” and incentives for data sharing, including use of data repositories.

Source: Center for Medical Technology Policy