Healthcare Industry News:  Cologuard 

Diagnostics Reimbursement

 News Release - January 2, 2015

Exact Sciences: Additional Update on CMS Reimbursement for Cologuard(R)

MADISON, Wis.--(Healthcare Sales & Marketing Network)--Exact Sciences Corp. (EXAS) today announced that the Centers for Medicare and Medicaid Services (CMS) has published an updated 2015 Clinical Laboratory Fee Schedule, which includes reimbursement for Exact Sciences’ Cologuard® noninvasive colon cancer screening test (CPT code G0464) at $492.72. Consistent with CMS’ Nov. 25 final payment decision, it will reimburse Cologuard based on a crosswalk to CPT codes 82274, 81275 and 81315. To establish the final 2015 reimbursement rate of $492.72 for CPT code G0464 (Cologuard), CMS utilized an internal calculation based on prior-year locality-specific payment rates for each of the component codes.

The $492.72 reimbursement amount for Cologuard is a national limitation amount (NLA) that is applicable across all states and applies to Cologuard tests provided to Medicare beneficiaries who are enrolled in traditional Medicare, which is also referred to as Medicare Fee for Service. Medicare Advantage plans are required by the recent national coverage decision to reimburse for the Cologuard test. Out-of-pocket costs for Medicare Advantage enrollees will be determined by the specific details of their respective plans.

“We are pleased with the final reimbursement rate for Cologuard,” said Kevin T. Conroy, chairman and chief executive of Exact Sciences. “We appreciate the work done by the team at CMS to make this important noninvasive colorectal cancer screening option available to the millions of patients covered by Medicare.”

About Exact Sciences Corp.

Exact Sciences Corp. (EXAS) is a molecular diagnostics company focused on the early detection and prevention of colorectal cancer. The company has exclusive intellectual property protecting its noninvasive, molecular screening technology for the detection of colorectal cancer. Stool DNA technology is included in the colorectal cancer screening guidelines of the American Cancer Society and the U.S. Multi-Society Task Force on Colorectal Cancer. For more information, please visit the company's website at www.exactsciences.com, follow us on Twitter @ExactSciences or find us on Facebook.

Certain statements made in this news release contain forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities and Exchange Act of 1934, as amended that are intended to be covered by the “safe harbor” created by those sections. Forward-looking statements, which are based on certain assumptions and describe our future plans, strategies and expectations, can generally be identified by the use of forward-looking terms such as “believe,” “expect,” “may,” “will,” “should,” “could,” “seek,” “intend,” “plan,” “estimate,” “anticipate” or other comparable terms. Forward-looking statements in this news release may address the following subjects among others: statements regarding Medicare reimbursement rates. Forward-looking statements involve inherent risks and uncertainties which could cause actual results to differ materially from those in the forward-looking statements, as a result of various factors including those risks and uncertainties described in the Risk Factors and in Management’s Discussion and Analysis of Financial Condition and Results of Operations sections of our most recently filed Annual Report on Form 10-K and our subsequently filed Quarterly Reports on Form 10-Q. We urge you to consider those risks and uncertainties in evaluating our forward-looking statements. We caution readers not to place undue reliance upon any such forward-looking statements, which speak only as of the date made. Except as otherwise required by the federal securities laws, we disclaim any obligation or undertaking to publicly release any updates or revisions to any forward-looking statement contained herein (or elsewhere) to reflect any change in our expectations with regard thereto or any change in events, conditions or circumstances on which any such statement is based.


Source: Exact Sciences

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