In January 2023, I missed a press reslease from CUREMATCH, Inc, that they were successful in getting a Category III code for a service that takes in biomarker data (from prior tests) and organizes algorithmic drug recommendations for oncologists. The code, when priced, will include both the software service and physician time.
The code, 0794T, is on a list of new Category III (temporary) codes from the AMA CPT. Find the list here.
- The code text is: Patient-specific, assistive, rules-based algorithm for ranking pharmaco-oncologic treatment options based on the patient's tumor-specific cancer marker information obtained from prior molecular pathology, immunohistochemical, or other pathology results which have been previously interpreted and reported separately.
In earlier years, it was rare if ever that CPT had preamble text before the words of the CPT code. That type of preamble is now more common for Cat III codes, and there is a long description as a "preamble" before the code text. See the AMA CPT link above.
This sounds similar to Clinical Decision Support (CSD), for which FDA has regulatory guidance. A CDS Coalition has demanded that FDA rescind its position - here.
GPT 4 summarizes the press release.
"CureMatch uses a proprietary curated knowledge base and an artificial intelligence platform to quantify and qualify therapy options based on each patient's molecular data. Oncologists and other providers can use the new CPT code indicating the need and demand for this precision oncology tool for a five-year period starting July 1, 2023. CureMatch's therapy matching system has been shown to improve progression-free survival in patients treated using combination therapies with higher molecular matching scores, as demonstrated in a 2019 I-PREDICT clinical study." And, "[The new code] will facilitate wider adoption and availability of precision medicine treatment options for cancer patients. CureMatch's proprietary AI platform helps oncologists make the best treatment decisions by analyzing massive amounts of data to quantify and qualify therapy options based on each patient's molecular data."
Fun fact. Lab industry experts know that PLA codes are company-specific. In contrast, although Category III codes may be lengthy and tailored, they are not actually company-specific but apply to the described services. In this case, the core service is, "algorithm for ranking pharmaco-oncologic treatment options based on the patient's tumor-specific cancer marker information."
Fun fact. I think this code might not be billable by a lab as a CLFS service, because it includes Physician Work and it would have to be classified as a CLIA code, I think, by CMS, to be billable by an entity enrolled as a lab. I'm not sure what it going to happen, though.
Flatiron Assist. See a service called Flatiron Assist, from Flatiron, a nice creative video at Vimeo.