MolDx Labs Question Missing Medicare Payment Amounts For Some Test Codes
This article was originally published in The Gray Sheet
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 concerns about perceived changes to the gap-fill regulation.
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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.
In recently updated clinical lab fee schedule rates, Medicare payment for BRCA1 and BRCA2 genetic testing goes down from $2,795 to $1,438, but Myriad Genetics believes the change might be a clerical error, repeating an issue from September.
“Why are insurers so reluctant to get enthusiastic and really embrace molecular diagnostics?” asked the director of CMS’ coverage and analysis group at a recent cancer diagnostics symposium. “Because half the time we have no idea what on earth we’re paying for.”