Lucid Diagnostics Advances EsoGuard Reimbursement: Medicare Panel Backs Gapfill, New CPT and ICD-10 Codes Approved

summarizeSummary

Lucid Diagnostics announced three reimbursement milestones for EsoGuard and EsoCheck: Medicare panel support for gapfill pricing, a new AMA CPT code, and a favorable CDC response to a proposed ICD-10 diagnosis code. The Texas lab will begin Medicare claims this month.

check_boxKey Events · Product Development and Regulatory · LUCD

• Medicare Panel Backs Gapfill Pricing

  The Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests recommended maintaining EsoGuard's original gapfill payment basis under the Clinical Laboratory Fee Schedule. CMS is expected to issue final determinations in November following a public comment period.

• New CPT Code Approved

  The AMA CPT Editorial Panel approved a new Category III CPT code for non-endoscopic esophageal cell collection procedures performed with EsoCheck, enabling physicians to report and track office-based procedures.

• ICD-10 Diagnosis Code Advances

  The CDC/NCHS ICD-10 Coordination and Maintenance Committee responded favorably to a proposed new ICD-10-CM diagnosis code (R85.83) for positive EsoGuard results, which would document clinical rationale for confirmatory endoscopy.

• Texas Lab Begins Medicare Claims

  Lucid will begin submitting Medicare claims this month under EsoGuard's PLA code 0114U for tests performed at its Texas laboratory, which is in a non-MolDX MAC jurisdiction.

auto_awesomeAnalysis · LUCD · Industrial Applications And Services

Lucid Diagnostics announced three separate regulatory and reimbursement wins for its EsoGuard esophageal precancer test and EsoCheck collection device. The Medicare Advisory Panel recommended maintaining EsoGuard's original gapfill payment basis, the AMA approved a new Category III CPT code for EsoCheck procedures, and the CDC/NCHS committee responded favorably to a proposed ICD-10-CM diagnosis code for positive EsoGuard results. These milestones directly address the company's biggest commercial bottleneck — getting paid for its tests — and come as Lucid faces a going-concern warning and a key debt waiver that expired in August. The Texas laboratory will begin submitting Medicare claims this month, which could accelerate revenue recognition. While the final CMS determination is not expected until November, the panel's recommendation is a strong positive signal for reimbursement stability.