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Invitae's Breast Cancer Tests Get New Medicare Reimbursement Code

NEW YORK (GenomeWeb) – Invitae announced today that its multi-gene tests for hereditary breast cancer-related disorders will now be reimbursed by the Centers for Medicare and Medicaid Services (CMS) under a new molecular diagnostics current procedure terminology (CPT) code.

According to Invitae, the tests will now be billed under the CPT code 81432, which Medicare contractor Palmetto GBA recently determined should be used for tests conducted by next-generation sequencing that include BRCA1, BRCA2, and 12 other genes even if they are part of multi-gene panels for assessing hereditary cancer syndromes. This guidance is in line with a draft local coverage determination issued last year by CMS.

The interim payment per test under the new code is $622.53 compared to $2,180.22 for BRCA1/2 mutation analysis. 

CMS will set final pricing for the code later this year, and the company said it has proposed a price of $950 for the agency and its contractors. Payments to San Francisco-based Invitae are made by Noridian, CMS's administrative contractor for California.

"We believe this decision sends an important message regarding the clinical utility and cost-effectiveness of multi-gene panels when applied in a medically responsible way based on peer-reviewed science and clinical guidelines," Invitae Chairman and CEO Randy Scott said in a statement. "We plan to continue working with additional private payors to encourage similar adoption of a more transparent and modern coding and pricing policy based on state-of-the-art technology advances."

Notably, Noridian is also the CMS administrative contractor for Myriad Genetics, which markets the 25-gene myRisk Hereditary Cancer panel that also includes BRCA genes. A Myriad spokesperson said that the new CPT code does not apply to the myRisk test, but declined to comment further.

In Tuesday morning trade on the New York Stock Exchange, shares of InVitae were up around 2 percent at $10.80.