For Providers

Medical Necessity

For Medicare and most commercial payers, a healthcare service must be reasonable and medically necessary for it to be covered.

Although medical coverage policies vary amongst third party payers, the criteria for medical necessity tend to encompass the following attributes. Our test meets or exceeds each of these criteria.

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For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms

The test is ordered for the purpose of differentiating between malignant melanomas and benign nevi, thereby enabling the physician to render a more definitive and accurate diagnosis.

In accordance with the generally accepted standards of medical practice

The test is ordered to evaluate melanocytic skin lesion biopsies that are classified as ambiguous based on clinical and histopathological evaluations. The test has been clinically validated and has the potential to aid physicians in providing a more definitive and accurate diagnosis.

Clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease

The test is ordered to objectively determine whether the proteomic contents of melanocytic skin lesions are more consistent with either malignant melanomas or benign nevi.

Not primarily for the convenience of the patient, health care provider, or other physicians or health care providers

The ordering physician must cite medical necessity based on the intent to use the test result as an aid in rendering a diagnosis and managing patient care.

Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease

The test compares favorably to existing tests, each dependent on an alternative technology, on the basis of accuracy, objectivity, required specimen material, turnaround time, and/or cost. MelaPro Dx is a proprietary test that is only available through New River Labs, LLC, and no other comparable test exists.