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CMS Signals Clinical Lab Fee Approach For Molecular Test Codes

This article was originally published in The Gray Sheet

Executive Summary

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.

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Latest news from the Medicare agency includes updates from the physician fee schedule and clinical laboratory fee schedule, an American Hospital Association lawsuit, and more.

Industry Groups Push CMS To Pay For Algorithms In Multi-Analyte Tests

The agency’s proposal not to separately pay for the algorithmic analysis that forms the basis of many multi-analyte molecular diagnostic tests misconstrues the nature of the tests, industry groups argue. They call for a final determination by CMS that more truly reflects the value of these assays.

Industry Groups Push CMS To Pay For Algorithms In Multi-Analyte Tests

The agency’s proposal not to separately pay for the algorithmic analysis that forms the basis of many multi-analyte molecular diagnostic tests misconstrues the nature of the tests, industry groups argue. They call for a final determination by CMS that more truly reflects the value of these assays.

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