Pending Medicare Fee-Schedule Selection For Gene Tests Has Significant Implications – Consultant

Which payment system should incorporate new molecular diagnostic codes? CMS’ decision could have unsettling results for some gene test makers.

If CMS elects to incorporate 101 new genetic testing codes into the physician payment system next year it could be a source of unpredictability for test manufacturers and labs, but selecting the laboratory fee schedule for the codes also has its pitfalls, according to a consultant in the space.

The codes were recently established to replace the current code “stacking” approach for many genetic test insurance claims to finally allow payers, including Medicare, to know more precisely which tests...

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