Supreme Court Lets Stand Breast Cancer Test Payment Denial

The U.S. Supreme Court Monday rejected a request to review Medicare’s decision not to reimburse Agendia Inc. for breast cancer diagnostic tests.

The U.S. Court of Appeals for the Ninth Circuit had upheld the reimbursement denial, which originated with a private contractor hired by the Department of Health and Human Services to establish coverage policies for diagnostic laboratory services.

Agendia, a precision oncology company, argued the coverage policies should have gone through notice-and-comment rulemaking. But a divided Ninth Circuit held there was no need for formal rulemaking because the contractor’s determination applied locally rather than nationwide.

The case is Agendia v. Becerra, U.S., No. 21-584, petition denied 1/24/22