The US Centers for Medicare and Medicaid Services (CMS) has recommended a final 'gapfill' price of US$1,328.32 for Pacific Edge's Cxbladder Triage Plus test.
This is higher than the US$1,018 draft price proposed in April.
The CMS price will determine the reimbursement amount for all patients with Medicare and Medicare Advantage insurance, pending coverage from Pacific Edge's Medicare Administrative Contractor, Novitas.
The Triage Plus test, which is currently listed as non-covered by Novitas, is being prepared for a reconsideration request by Pacific Edge.
The company said the Triage Plus price is a significant increase compared to the US$760 CMS price of its existing tests.
The final CMS price is expected to become effective on January 1, 2026.
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