Biovica, active in cancer monitoring, today announces that the Center for Medicare & Medicaid Services (CMS) has issued a preliminary CLFS payment decision for DiviTum TKa to pursue the gap-fill process during 2024. The gap-fill process is an established route to an anticipated own PLA pricing code. The process is used for unique tests where there are no comparable tests on the market. CMS will consider previously negotiated rates with private payers and charges for the test, and additional factors.
“We are eager to collaborate closely with CMS and embark on the gap-fill process. This established procedure will ensure that DiviTum TKa is priced appropriately. In this process, we will benefit from the commercial agreements already signed where rates have been established. Throughout the process, we will be able to bill for DiviTum TKa at a provisional price," said Warren Cresswell, President of the Americas at Biovica.
This preliminary Clinical Laboratory Fee Schedule (CLFS) payment decision is anticipated to be announced as final in December 2023 and Biovica plans to engage in the gap-fill process in 2024. The process is expected to take around one year and the PLA code along with its pricing is expected to be implemented from January 1, 2025. During the process, Biovica will continue to bill for Medicare services through its Medicare Administrative Contractor using
a provisional price.