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Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers decision memo from the Centers for Medicare & Medicaid Services (CMS)

October 8, 2019

There are important changes to the CAR T-cell therapy for certain types of cancer considered a significant cost for contract years 2019 and 2020.

CMS announces that the National Coverage Determination (NCD) requiring coverage of chimeric antigen receptor (CAR) T-cell therapy for certain types of cancer is a significant cost under section 422.109(a)(2) of title 42 of the Code of Federal Regulations. As a result, for calendar years 2019 and 2020 only, original fee-for-service Medicare will pay for CAR T-cell therapy for cancer obtained by beneficiaries enrolled in Medicare Advantage plans when the coverage criteria outlined in the NCD is met.

Consistent with §1862(t)(2) of the Act, Medicare Administrative Contractors will pay for CAR T-cell therapy for cancers for Medicare beneficiaries enrolled in Medicare Advantage plans in Contract Year (CY) 2019 and 2020.

For more information, see the decision memo on the CMS website at:
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=291

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