Coverage expands for prostate cancer test, PTNS

Insurance coverage has expanded for an epigenetic test for prostate cancer and percutaneous tibial nerve stimulation (PTNS) for the treatment of overactive bladder (OAB).

MDxHealth SA said it has signed agreements with HealthSmart, a preferred provider organization network, and Fortified Provider Network to provide their members access to the ConfirmMDx for Prostate Cancer test. The addition of these agreements extends ConfirmMDx for Prostate Cancer testing to more than 135 million insurance covered lives throughout the United States, the company said.

HealthSmart is a group of managed health care companies dedicated to providing comprehensive and innovative health care solutions to meet client needs. Fortified Provider Network is a national direct-contracted preferred provider network that is utilized by self-funded employer groups, insurance carriers, and regional and local provider networks that process end-user patient claims.

“Insurance providers recognize that ConfirmMDx provides physicians with actionable information that helps improve patient care and that avoidance of unnecessary repeat prostate biopsies reduces spending associated with these invasive procedures," said Jan Groen, PhD, of MDxHealth.

Separately, Uroplasty, Inc. announced that Medical Mutual has written a positive coverage policy for PTNS delivered via the company’s Urgent PC Neuromodulation System for treatment of OAB and associated symptoms of urinary urgency, urinary frequency, and urge incontinence.  Medical Mutual is a large, regional private insurer with approximately 2.7 million covered lives, primarily in Ohio, as well as Georgia, Indiana, Michigan, Pennsylvania, South Carolina, and West Virginia.

"With the addition of Medical Mutual, we now have approximately 108 million lives covered by private payers and 40 million Medicare beneficiaries with access to Urgent PC therapy," said Nancy Kolb of Uroplasty.

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