Watching and Waiting for Codes and Fees

January 6, 2015
Watching and Waiting for Codes and Fees
Lab reimbursement is going through major changes, both in terms of coding and reimbursement. [Ki33/Fotolia­]

Alex Philippidis

Clinical laboratories will be watching and waiting in the new year for the Centers for Medicare and Medicaid Services (CMS) to resolve several unsettled issues concerning fees for molecular pathology tests, as well as coding for drug-screening tests.

CMS approved 21 new codes for advanced genomic studies such as exome sequencing and whole genome sequencing, as well as a range of hereditary and cancer/somatic mutation genetic panels.

However, CMS directed instead that they be set in 2015 via “gapfilling.” Local Medicare Administrative Contractors (MACs) will set fee schedule amounts during the first quarter of 2015, to be released for public comment. The contractors will submit final prices in or about August 2015, with CMS expected to publish the medians and set 2016 prices at those medians.

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