New CMS Lab Test Panel Meets To Make Payment Policy Recommendations
This article was originally published in The Gray Sheet
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.
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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.
A new law makes vast changes to how clinical laboratory tests will be reimbursed by Medicare over the long term. Although the changes ultimately may lead to payment reductions, both test kits makers and laboratories applaud the new provisions. Reimbursement will better reflect the value that lab tests bring to the health care system, they say.
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.