A query- what if there is no decision made in the times mentioned. BAU??
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At the end of the day, its a gamble... But in my opinion, there are a number of factors that suggest its more likely that medicare coverage will be kept. Firstly, PEB and it's tests have compelling support from the main players in the urology industry in the USA, advocating for Medicare to be maintained. The idea is that by maintaining Medicare coverage of these tests, there is a public health benefit/overall cost saving. Secondly, Novitus will need to rebutt the Strata research and the support that this research has gained. I'm not sure if they can feasibly do this in a way that doesn't compromise their procedure and position within the time period they have. Sure Novitas can just say no, but procedurally they should back that up with sound rationale or evidence, else legally, the decision could be easily challenged and it would be a terrible look. Lastly, I think Novitas has a few options, e.g. allow coverage to be kept or raise another lcd after this one had lapsed. Of the options, these two options are safer than canceling coverage. There are some other things like elections and the FDA adding another layer of compliance and PEBs tests possibly getting guideline inclusion, these points arnt here or there but are positive for maintaining Medicare coverage.
Please DYOR, these are just my thoughts.
Is the A Bank still in on this gamble ? :)
compelling support from the main players in the urology industry in the USA
Can you qualify this please
The American Urological Association (AUA), the Large Urology Group Practice Association ,(LUGPA), and the American Association of Clinical Urologists (AACU) and Kaiser support a decision for PEB to maintain Medicare coverage. Kaiser submitted their own research to support PEB.
I'm also not sure Novitas needs rebutt a study funded by Pacific Edge?
It's on the PEB website. Some of it is here
https://www.pacificedgedx.com/news-a...-medicare-lcd/ ,but the information will be scattered across a few pages.