MolDx Labs Question Missing Medicare Payment Amounts For Some Test Codes
This article was originally published in The Pink Sheet Daily
Clinical laboratories plan to talk to CMS about its decision to list only 65 out of 114 new molecular pathology codes when it released revised gap-fill pricing Sept. 30, as well as their concerns about perceived changes to the gap-fill regulation.
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CMS is proposing a comprehensive review process to ensure test payments account for changes in technology. The effort would likely lead to pay reductions in many instances to address new efficiencies in the lab. In addition, double-digit cuts in lab payments are proposed in the agency’s 2014 physician fee schedule draft.
Molecular Dx Labs’ Concerns Shift To Coverage Issues With Release Of Interim Medicare Payment Amounts
Now that CMS has posted the interim payment amounts for more than 100 new molecular pathology codes, industry is concerned whether the tests will be covered at all.
Diagnostic industry players support the regional Medicare contractor’s evidence-based reimbursement requirements for molecular diagnostics and are hoping CMS adopts the approach nationally.