Tuesday, May 18, 2010 2:51:37 PM
>>>A reasonable place to start for estimating the bare minimum value of the HDVY urine test for PC is the Medicare reimbursement rate for the PSA test. A new test that replaces the PSA test would likely start out receiving reimbursement at the same rate as the PSA test. It's already in the fee schedule. Initially they would do what is called 'crosswalking'. They 'crosswalk' the new test to the test that already has a CPT code, and reimburse the new test at the same rate.<<<
Its even better news than that.
As you know, our urine PC test is not a simple antigen test, but a gene expression test. The cpt code is different. Even the PSA, Free and Total has an additional CPT code. This test should have several sequencing CPT codes - we will be using the current sequencing CPT codes. This is why esoteric testing is more difficult to bill out than routine testing - more complexity equals more cpt codes. Bottom line, Medicare Expect will be much, much higher than the current PSA. In return, billions of dollars will be saved by our healthcare system from the elimination of multiple (shot gun approach) biopsies and early detection of cancer - which is very expensive when it becomes late stage and terminal.
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