Medicare Covers Pacific Edge Bladder Cancer Tests
A new Medicare policy makes Pacific Edge's Cxbladder Triage and Triage Plus tests the only covered options for evaluating intermediate-risk microhematuria.
Updated on Nov. 5, 2026 in Cancer
Pacific Edge confirmed Medicare coverage for its Cxbladder Triage and Triage Plus tests after Medicare published a final Local Coverage Determination establishing hematuria evaluation as a covered benefit. Competing tests and generic billing codes are non-covered under the policy.
Why it matters
The policy sets coverage rules for urine-based biomarkers used to evaluate patients with microhematuria, a condition that can signal bladder cancer. Pacific Edge expects the decision to influence Medicare Advantage and commercial payers as well.
The final Local Coverage Determination is the governing document, and Triage, Monitor and Triage Plus are priced at US$1,057, US$1,026 and US$1,328 per test respectively. Pacific Edge has not quantified the projected increase in average selling price tied to Medicare reimbursement.
The players
Pacific Edge
Pacific Edge is a global cancer diagnostics company, headquartered in Dunedin, New Zealand, that develops bladder cancer diagnostic and prognostic tests.
Medicare
Medicare is the U.S. federal health insurance program for people aged 65 and older and certain younger people with disabilities, administered by the Centers for Medicare & Medicaid Services.
The details
Under the Local Coverage Determination, only the Cxbladder Triage and Triage Plus tests are covered, while competing tests and generic billing codes are non-covered. The policy establishes foundational guidelines for validated urine-based biomarkers in evaluating intermediate-risk microhematuria patients, and it takes effect on 20 December 2026.
Timeline
5 November 2026: Pacific Edge confirms the Medicare coverage announcement.
20 December 2026: The Medicare LCD policy takes effect.
Roadmap
Medicare's Local Coverage Determination process determines which diagnostic tests receive federal reimbursement, shaping which tools clinicians use to evaluate microhematuria. This decision extends that framework to urine-based bladder cancer biomarkers, with Pacific Edge expecting Medicare Advantage and commercial payers to follow.
Patients evaluated for microhematuria may encounter Cxbladder Triage or Triage Plus as covered options under Medicare once the policy takes effect on 20 December 2026. Coverage rules determine whether a test is billed to Medicare, which affects out-of-pocket cost.
The takeaway
Medicare coverage decisions can determine which diagnostic tests clinicians use for bladder cancer evaluation. Patients with blood in the urine should ask their clinician which covered tests are appropriate for their situation.
Further reading
Explore more cancer news and diagnostics coverage for context on how payer decisions shape screening tools.
