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

This article was originally published in The Gray Sheet

Executive Summary

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

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CMS Signals Clinical Lab Fee Approach For Molecular Test Codes

The agency did not make any final decisions in a recent proposal tied to its annual clinical lab fee setting process, but CMS gave a sense that at least some of the 101 newly created genetic test codes would be paid for under the lab fee schedule, rather than the physician fee schedule, using the “gap-fill” process.

CMS Signals Clinical Lab Fee Approach For Molecular Test Codes

The agency did not make any final decisions in a recent proposal tied to its annual clinical lab fee setting process, but CMS gave a sense that at least some of the 101 newly created genetic test codes would be paid for under the lab fee schedule, rather than the physician fee schedule, using the “gap-fill” process.

Genetic Tests As Physician Fees Or Lab Fees? CMS Asks For Input

How much physician “work” is required for the application of genetic tests will determine how CMS begins reimbursing for more than 100 assays in 2013.

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