On November 20, 2020, CMS closed out the new codes crosswalk/gapfill process for CY2021, by posting final pricing decisions.
In a striking contrast from Fall 2019, CMS did not change any of the pricing decisions proposed in September 2020.
- Last year, CMS disagreed with the advisory panel about half the time in its proposed decisions (September 27, 2019). Last year, CMS changed about 20 codes between proposed and final (mostly by changing crosswalks to gapfills; December 4, 2019.)
- On 8X008, JAK2, exons 12,13, and on 8X006, MPL, common variants, CMS crosswalked to Tier 2 codes rather than specific crosswalks (agenda 95,96).
- Agenda items 40-45 were crosswalked to drug code G0480 rather than gapfilled as recommended by panelists.
- Two CPT codes were added together to price 3 new tests.
- CMS used fractions three times:
- One code was multiplied by 2.5x, and two codes were a base code and fraction of a second code.