Lumos Expands Medicare Coverage for FebriDx to Six US Regions
Lumos Diagnostics has secured Medicare reimbursement for its FebriDx test from a sixth Medicare Administrative Contractor, covering over 85% of US Medicare payment regions. This milestone advances the company’s commercialisation efforts in the US healthcare market.
- Medicare reimbursement secured from sixth MAC, CGS Administrators
- Coverage now spans over 85% of US Medicare payment regions
- Reimbursement rate set at US$41.38 per FebriDx test
- Only one MAC remains to be secured for full Medicare coverage
- Medicare coverage often influences private insurance reimbursement
Lumos Advances US Market Access
Lumos Diagnostics (ASX: LDX) has achieved a significant commercial milestone by securing Medicare reimbursement coverage for its rapid point-of-care diagnostic test, FebriDx, from CGS Administrators. This latest approval, retroactive to May 1, 2025, marks the sixth of seven Medicare Administrative Contractors (MACs) to cover the test, representing over 85% of the US Medicare payment landscape.
CGS Administrators manages Medicare payments in Kentucky and Ohio, expanding Lumos’ footprint in key US states. This follows recent approvals from other MACs including Novitas, Palmetto, First Coast Service Options, Noridian Healthcare Solutions, and WPS Health Solutions. Only National Government Services (NGS) remains as the final MAC pending coverage approval.
Strategic Importance of Medicare Coverage
Medicare reimbursement is a critical validation step for diagnostic companies like Lumos. Medicare accounts for roughly 20% to 24% of the US healthcare payor mix and often sets a precedent for private insurers to follow. By securing coverage from six MACs, Lumos significantly enhances the commercial viability and accessibility of FebriDx to Medicare beneficiaries nationwide.
The reimbursement rate for FebriDx has been set at US$41.38 per test, providing a clear financial framework for healthcare providers to adopt the technology. Lumos’ Managing Director Doug Ward emphasized the company’s commitment to integrating FebriDx into clinical care pathways that benefit patients and deliver value to the broader healthcare system.
Looking Ahead: Commercialisation and Adoption
While Medicare coverage is a major step forward, Lumos’ broader commercial success will depend on demonstrating clear clinical benefits, improving diagnostic efficiency, and proving economic advantages to healthcare providers. The company is actively negotiating with the remaining MAC and pursuing reimbursement discussions with private payors to achieve nationwide access.
As Lumos continues to expand its reimbursement footprint, the company is positioning FebriDx as a leading rapid diagnostic tool in the US market, potentially reshaping how infectious and inflammatory diseases are diagnosed at the point of care.
Bottom Line?
With Medicare coverage nearing completion, Lumos is poised for broader US adoption—but private payor negotiations remain a critical hurdle.
Questions in the middle?
- When will the final Medicare Administrative Contractor approve FebriDx reimbursement?
- How quickly will private insurers follow Medicare’s lead on coverage decisions?
- What clinical data will Lumos present to accelerate adoption among healthcare providers?
