Full Medicare Recognition for FebriDx Raises Stakes for Lumos’ US Market Growth
Lumos Diagnostics has achieved a major milestone by securing 100% Medicare reimbursement recognition for its FebriDx test across all seven US Medicare Administrative Contractors, paving the way for broader adoption in the American healthcare system.
- Complete Medicare reimbursement coverage secured for FebriDx at US$41.38 per test
- National Government Services (NGS) finalizes coverage, covering key Midwestern and Northeastern states
- All seven Medicare Administrative Contractors now recognize FebriDx under Clinical Lab Fee Schedule
- Next focus on formalizing written policies to streamline reimbursement claims
- Partnership with PRO-spectus to integrate coverage into Medicare Advantage, Medicaid, and private payors
A Landmark Achievement in US Healthcare Access
Lumos Diagnostics (ASX – LDX) has announced a significant breakthrough in its US market strategy by securing full Medicare reimbursement recognition for its rapid diagnostic test, FebriDx. This milestone comes with the inclusion of National Government Services (NGS), the seventh and final Medicare Administrative Contractor (MAC), which manages Medicare payments across Illinois, Minnesota, Wisconsin, New England, and New York. With NGS on board, FebriDx is now recognized by all seven MACs, ensuring nationwide Medicare coverage at a reimbursement rate of US$41.38 per test.
Implications for Broader Adoption
This comprehensive Medicare coverage is a critical step toward wider adoption of FebriDx in the US healthcare system. Medicare accounts for roughly 20% to 24% of the US payor mix, and full MAC recognition not only unlocks access across all geographic regions but also sets the stage for uptake by Medicare Advantage and Medicaid plans. These payors often align their reimbursement policies with the Centers for Medicare and Medicaid Services (CMS) fee schedules, meaning Lumos’ achievement could cascade into broader insurance coverage.
Next Steps – Policy Formalization and Claims Efficiency
While reimbursement recognition is a crucial milestone, Lumos’ immediate focus shifts to working with each MAC to establish formal written policies. These policies are essential for providing clarity and predictability to healthcare providers and payors, enabling more efficient reimbursement claims processing. Lumos’ partner, PRO-spectus, will play a pivotal role in assisting MACs and other payors to integrate FebriDx coverage into their internal frameworks, further smoothing the path to adoption.
Strategic Positioning and Market Potential
Doug Ward, Managing Director of Lumos Diagnostics, highlighted the significance of this achievement, describing it as a landmark that positions FebriDx for broad adoption across the US healthcare landscape. The full Medicare recognition not only enhances access but also strengthens Lumos’ commercial prospects by opening doors to private payors and expanding the test’s reach to clinicians and patients who stand to benefit most from rapid, point-of-care diagnostics.
As Lumos moves forward, the company’s ability to translate reimbursement recognition into actual market penetration and revenue growth will be closely watched by investors and industry observers alike.
Bottom Line?
With full Medicare reimbursement secured, Lumos is poised to accelerate FebriDx adoption, but execution on policy and payor integration will be key.
Questions in the middle?
- How quickly will formal written policies be established with each Medicare Administrative Contractor?
- What is the expected timeline for Medicare Advantage and Medicaid plans to adopt FebriDx coverage?
- How will private payors respond to this Medicare reimbursement milestone in their own coverage decisions?
