CMS Gets Pricing Advice for New 2014 CPT Lab Codes

Leading scientific societies and national clinical laboratory and pathology groups recommend that the Centers for Medicare and Medicaid Services (CMS) use the crosswalk method to set payment rates for virtually all of the new Current Procedural Terminology test codes to be added to the Part B lab fee schedule as of Jan. 1, 2014. Final determinations for the 2014 clinical laboratory fee schedule are due out in September. The groups differed on some recommendations for reconsideration requests, with some suggesting crosswalking, others not offering recommendations, and some urging CMS to use gap-filling. Under the crosswalk methodology, a new test code is matched to an existing code on the fee schedule and is paid at that rate. The gap-fill alternative is used when there is no comparable existing test. Local Medicare contractors set the fee for the first year based on local pricing patterns. Recommendations from four organizations shown in the table on pages 2-3 were submitted to CMS at its July 10 public meeting, which kicked off the annual process to get pricing input from industry stakeholders.