Pacific Edge Updates Billing Policies for US Testing

Pacific Edge today announces an update to its billing policies in the US for Cxbladder tests.

From 17 July 2023, Pacific Edge will provide for enhanced patient responsibility where a patient’s insurer declines to pay for a Cxbladder test. Pacific Edge will also update its Patient Assistance Program to assist lower income patients with making their bill more affordable.

The new process requires all patients not covered by a contracted health insurer to be informed by the ordering physician of the patient’s responsibility when ordering the test. All patients will be required to sign an Advance Beneficiary Notice of Non-Coverage (ABN). They will also be encouraged to complete a Patient Assist form as part of the test ordering process. Where a patient’s sample is received without ABN and Patient Assist forms, customer service agents will contact the patient to obtain complete information before the test is processed.

The Enhanced Patient Responsibility approach follows the finalization in early June of a Local Coverage Determination (LCD) that could see Medicare coverage of Cxbladder tests cease on 17 July 2023. Medicare and Medicare Advantage tests represented ~60% of commercial Cxbladder tests performed in the year to 31 March 2023, accounting for 77.7% of Operating Revenue.

Pacific Edge Chief Executive Dr Peter Meintjes said: “Despite the determination by Novitas, thousands of urologists across the US and around the world share our view that Cxbladder offers clinically valuable and actionable information. This information can improve the standard of care for patients suspected of or previously affected by bladder cancer, can offer improved patient management options for physicians, and spare patients from unnecessary invasive urinary tract examinations.

“When clinicians explain to patients that a Cxbladder test may allow them to safely avoid a cystoscopy, we expect many will accept some patient responsibility for payment if their insurer declines to cover the test”.

“While the impact on demand for our tests in the US is uncertain, we expect the new approach to improve collections in the event of denial from any non-contracted insurer, including Medicare and make some contribution to revenues after 17 July.”

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