Flow Cytometry TC Could Be Cut by 75%

The July 8 proposal by the Centers for Medicare and Medicaid Services (CMS) to cut the technical component (TC) of certain pathology codes paid under the physician fee schedule (PFS) would hit independent laboratories especially hard. Under the proposed rule, CMS would cap TC payment of affected pathology services at the rates paid under Medicare’s hospital outpatient prospective system. For example, CPT 88185, flow cytometry, would be cut by 75 percent, while the TC of CPT 88307, tissue exam by pathologist, would be cut by 50 percent. Since the proposal targets only the TC of pathology services paid under the PFS, pathologists who bill only the professional component of these codes would not be affected. However, independent labs that perform the technical component of pathology tests could see substantial payment reductions. According to CMS, the proposed policy change accounts for a 6 percent reduction in overall Medicare PFS payment to pathologists and a corresponding 25 percent cut to independent laboratory PFS payments. As part of the July 8 proposal, CMS also proposes several changes to the value-based payment modifier program that affect pathologists.