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does medicare cover foundationone testing

Does Medicare Cover FoundationOne Testing?

Foundation Medicine is a company that plans to help healthcare professionals and providers, and cancer patients by providing more research and treatment options regarding cancer.

They also provide specific tests that can help patients diagnosed with cancer. However, these tests are not easily affordable. A common question many people have is, “does Medicare cover FoundationOne Testing?” In this article, we answer the question in clear, plain English. You will also find the average costs of Foundation One Testing, as well as other helpful info.

Does Medicare Cover FoundationOne Testing?

The short answer is yes; Medicare will cover the cost of treatment for plantar fasciitis. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your treatment for plantar fasciitis. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for FoundationOne tests such as FoundationOne® Heme, FoundationOne®CDx, and FoundationOne®Liquid CDx.

However, for Medicare to give coverage for Foundation One test, certain criteria have to be met. For both Foundation One CDx and Foundation One Liquid CDx, here are the criteria for the patient:

  • A diagnosis of solid malignant neoplasm
  • Having as either recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer
  • Has not tested the same test using NGS as before for the same cancer genetic content
  • A decision to move further in treating his/her cancer.

For Medicare to cover Foundation One Heme, these specific criteria have to be met for the patient:

  • A diagnosis of refractory/metastatic acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN), or a suspicion of having myeloid malignancy with an undefined cytopenia for more than four months and all other possible causes have been excluded reasonably
  • Has not received or is not currently receiving NGS testing on the specific specimen
  • Patient has not tested the same test for the same genetic content

Once those criteria are met, Medicare will usually cover all expenses for the tests.

Medicare Advantage plans also provide coverage for Foundation One Testing. They cover everything Original Medicare covers and also offer some additional benefits.

How Much Does Foundation One Testing Cost?

Foundation One Testing, regardless if it is Foundation One Heme, Foundation One CDx, or Foundation One Liquid CDx, costs $3,500.

What Is Foundation Medicine?

Foundation Medicine is a company that aims to transform and improve cancer treatment. They can do that by gaining more knowledge about cancer’s molecular underpinnings.

They believe that cancer is unique, so they provide specific genomic insights for each patient through their genomic tests. And through that genomic insight, they can help doctors create a personalized care plan for each patient.

Each care plan can help the patient by matching his/her cancer with relevant, targeted therapies, immunotherapies, and clinical trial options.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover pedicures?

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