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.
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.
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.
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.
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.
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.