CMS Gets Pricing Advice for New 2014 CPT Lab Codes

Clinical laboratory representatives gathered at the headquarters of the Centers for Medicare and Medicaid Services (CMS) this week to give recommendations on pricing of new and reconsidered codes for the 2014 Medicare clinical laboratory fee schedule. While CMS officials requested that meeting participants not give recommendations on pricing of new molecular pathology (MoPath) codes currently being priced through the gap-filling process, there are two new Tier 1 molecular pathology procedures that were open for comment: CPT 81161—DMD, used for diagnosis of Duchenne/Becker muscular dystrophy, and CPT 812XX—MGMT (O6-methylguanine DNA methyltransferase), used for diagnosis and treatment of brain cancer. The American Clinical Laboratory Association (ACLA) in its comments said it considered recommending a crosswalk to one of the existing Tier 1 or Tier 2 MoPath codes, but with pricing still in flux and some carriers not pricing all the codes, there is no sufficient crosswalk at this time. ACLA recommends that CMS take the median of the code stacks that were used to bill this test prior to the adoption of the Tier 1 MoPath codes. For more on recommendations presented at the July 10 lab meeting, see the next issues of Laboratory Industry Report and National Intelligence Report.