Biomerica Opens Medicare Claims Pathway for inFoods IBS with $300 Reimbursement Rate
Biomerica’s inFoods IBS test is now eligible for individual claim review by the Medicare Administrative Contractor under the existing $300 CMS payment rate. The test carries a dedicated CPT PLA code effective October 1, 2025 and will be adjudicated through a single MAC jurisdiction for streamlined submissions.
1. MAC Confirms Individual Claim Review
The Medicare Administrative Contractor responsible for processing inFoods IBS claims has confirmed that each test will be evaluated individually under Medicare’s reasonable and necessary standard, provided that providers supply appropriate diagnosis codes and documentation of medical necessity. This follows CMS guidelines for diagnostic tests without a formal national or local coverage determination.
2. Established Billing Code and Reimbursement Rate
The inFoods IBS test has been assigned a dedicated CPT PLA code effective October 1, 2025 and benefits from a CMS-established national payment rate of $300 per test for services rendered on or after January 1, 2026. These prerequisites create a standardized billing pathway and clarify reimbursement expectations for providers.
3. Pathway to Near-Term Revenue
All Medicare submissions for inFoods IBS will be routed through a single MAC jurisdiction managed by Biomerica’s CLIA-certified laboratory partner, Ethos Laboratories, simplifying claim adjudication. Biomerica is preparing initial submissions and anticipates that this Medicare pathway will translate into scalable, near-term revenue growth.