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MolDx Labs Question Missing Medicare Payment Amounts For Some Test Codes

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.

Laboratories that run molecular diagnostic tests were not surprised by the revised reimbursement rates that CMS recently released for new molecular pathology codes including the 2014 National Limit Amount, but they are concerned that the agency only posted revised reimbursement rates for 65 of the original 114 new codes slated for pricing under the “gap-filling” method.

Along with the revised 2013 payment amounts for molecular pathology codes established by local Medicare administrative contractors, CMS also posted to its website Sept

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