Molecular Dx Labs’ Concerns Shift To Coverage Issues With Release Of Interim Medicare Payment Amounts
This article was originally published in The Gray Sheet
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.
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The Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests held its inaugural meeting Aug. 26 to begin work on recommending crosswalks and gapfills for more than 25 molecular tests codes.
Labs and test makers say they are confused about what if anything Medicare contractors are paying for various molecular diagnostics including next-generation sequencing following CMS' recent release of codes and pricing for 2015. Meanwhile, industry groups are anxious that the agency has yet to issue a proposed rule to implement broader statutory changes to diagnostic price-setting.
CMS has extended the comment period on its nearly 50 percent BRCA testing reimbursement cut to the end of February. But comments from lab and diagnostics groups so far try to underscore the “capriciousness and lack of transparency” that CMS displayed when it made the cut. Experts say the agency is unlikely to change its mind.