Wednesday, November 19, 2025

New AMA CPT Text Defines Rules for PLA Code Changes (In a Vague Way)

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In a previous blog, I noted that updated online PLA code instructions seem to disallow "distributed testing models" that may be ap...
Tuesday, November 18, 2025

Hemoglobin A1c testing, and the Truly Mysterious Case of Code 83037 and PAMA

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If you go back to tables released when PAMA pricing was new in 2018, you'll find that the surveyed median price of 83036 - laboratory h...

Brief Blog: Winter CPT Code Applications Out for Comment (November 15-30)

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 AMA's next CPT meeting is in Palm Springs, February 5-7, 2026. https://www.discoveriesinhealthpolicy.com/2025/11/ama-opens-registration...

Resources: Value in Health Offers Special Issue on AI in Health Economics (November 2025)

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 Value in Health, the official journal of ISPOR, the international pharmacoeconomics/HEOR organization, focuses on AI in HEOR for November 2...

Update: CAP Accreditation Allows "Distributed Model" Testing - But AMA CPT PLA Will Not

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In recent quarters, a number of PLA applications have been rejected either because they were " dry lab only" services (e.g. start...
Monday, November 17, 2025

Legislation: Where to Find It: Delay Lab Pricing 30 Days. Spend $50B for Rural Health Technology.

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 Too pieces of recent legislation and where to find them. HR 5731 and Section 6209 PAMA The bill that ended the Fall 2025 government shutdow...

Siemens' Remarkable Comments to CMS on Software Reimbursement - the New "Must-Read?"

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 For several years CMS has struggled with changing, vague, or counterproductive policies for how topay for software-dominant services.   Thi...
Sunday, November 16, 2025

Prasad & Makary: Radical New Ideas for Drug Approvals; Do They Matter to Diagnostics??

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 On November 12, 2025, NEJM published an important new essay by Vinay Prasad MD and Martin Makary MD, the head of drug approvals and the com...
Friday, November 14, 2025

ACLA Scores Short-Term Win in PAMA Pricing!

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With the budget that reopened the government on November 13, 2026, ACLA scored a short term win in delaying PAMA cuts.  I'll quote them...
Thursday, November 13, 2025

Trump Administration: Far Less Rulemaking 2025 vs 2024

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Did the Trump Administration do far less rulemaking in their first year than Biden in year four? Last year, the Physician Fee Schedule final...

For-Example AI Essay: CLIA Registration but not a License [REVISED]

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[REVISED] Someone was talking to me about a lab having "CLIA Registration but not a License." The question is a source of immediat...