NCCN Updates
NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Head and Neck Cancers to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers v2.2023.
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NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Endometrial Carcinoma to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Uterine Neoplasms v2.2023.
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NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for B-Cell Lymphomas. These NCCN Guidelines® are currently available as Version 5.2023.
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NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Gastrointestinal Stromal Tumors (GIST) to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Gastrointestinal Stromal Tumors (GIST) v1.2023.
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FDA Approvals
On July 20, 2023, the Food and Drug Administration approved quizartinib (Vanflyta, Daiichi Sankyo, Inc.) with standard cytarabine and anthracycline induction and cytarabine consolidation, and as maintenance monotherapy following consolidation chemotherapy, for the treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) that is FLT3 internal tandem duplication (ITD)-positive, as detected by an FDA-approved test.
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Updated KEYTRUDA® Indication
KEYTRUDA® (pembrolizumab) Injection 100 mg is indicated for the treatment of adult and pediatric patients with unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) solid tumors, as determined by an FDA-approved test, that have progressed following prior treatment and who have no satisfactory alternative treatment options.
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Genentech is pleased to announce the US Food and Drug Administration (FDA) approval of COLUMVI™ (glofitamab-gxbm), a T-cell engaging bispecific antibody. COLUMVI (glofitamab-gxbm) is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma not otherwise specified (DLBCL).
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Coding and Reimbursement Updates
View the July E-Reimbursement Newsletter
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On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2024 Medicare Physician Fee Schedule (PFS) and updates to the Quality Payment Program (QPP). The agency also released the 2024 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule.
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CMS & Noridian Updates
Incident to Billing Webinar – August 24, 2023
The Noridian Provider Outreach and Education (POE) staff is hosting the Incident to Billing webinar on 08/24/2023 at 1:00 PM PT.
This event includes: Incident to; Overview and Coverage; Supervision; Nonphysician Practitioners; Split/Shared; Substitute Providers
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Billing and Coding: MolDX: Germline Testing for use of PARP inhibitors (A55294) – R10 – Effective July 28, 2022
This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).
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MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease (L36180) – R12 – Effective July 06, 2023
This Local Coverage Determination (LCD) has been revised under contractor numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, and NMI), and 01312 (NV).
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Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers (A58454) – R4 – Effective July 06, 2023
This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).
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Billing and Coding: MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung Cancer (A57664) – R2 – Effective July 01, 2023
This coverage article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (HI and Territories), and 01312 (NV).
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AstraZeneca is pleased to announce that IMJUDO® (tremelimumab-actl) has been assigned a unique Healthcare Common Procedure Coding System (HCPCS) code and Average Sales Price (ASP) by the Centers for Medicare & Medicaid Services (CMS).
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State and National Legislative & Regulatory Issues
California Supreme Court rules CMA can sue Aetna Health under Unfair Competition Law
The California Medical Association (CMA) has achieved a significant victory for providers, consumers and public interest advocates in the case of California Medical Association v. Aetna Health of California Inc. The California Supreme Court ruled unanimously in favor of CMA, confirming the organization’s legal standing to sue Aetna Health for alleged violations of the Unfair Competition Law.
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