Tuesday, November 17, 2015

CMS Finalizes CY2015 Gapfill Prices

CMS has released final decisions on the CY2015 gapfill process, that is, for codes that were new in January 2015.   There was a stir in September 2015, when the 5-50 tumor gene codes were priced at only around $600 and Oncotype DX was priced somewhat below its historic CMS price.

In the final gapfill pricing, both Oncotype DX and Nanostring Prosigna are priced at $3416 for CY2016.   The codes for 5-50 tumor genes (81445, solid tumor; 81450, hematolymphoid tumor) were still priced at $597 and $647 respectively.

There is *no* CMS price for the 50+ tumor gene code (81445).

At the CMS website, here, see the file for "2015 CLFS Gapfill Final Determinations."