Monday, September 11, 2017

CMS Convenes Meeting on Sept 25: How to Handle Low Volume Codes under PAMA

CMS has announced a new meeting of the laboratory panel advisory group created by PAMA.   The meeting will occur by webinar/teleconference on Monday September 25, and the topic will be how CMS will handle low-volume or no-volume codes under PAMA Section 216.
  • The CMS announcement is here.  (82 FR 43239, 9/14/2017).
  • For further updates between now and the meeting, HERE (Sept 20).

PAMA section 216 re-calibrates the Clinical Laboratory Fee Schedule (CLFS) by applying new prices that are the medians of market prices determined by a survey of private payer payments (data must be turned over by labs.)   In rulemaking last summer, CMS determined that codes with no data would go into a crosswalk-gapfill process.  However, CMS tells us that it is now confronted with some 60 CPT codes with either no data, or "too little data" to establish a price.  (Sic.)  In the July 31/August 1 summer lab policy meetings, CMS proposed it may just delete such codes from the CLFS.  Stakeholders responded that CMS had no such authority: There was no legal definition of "too little data" and CMS had already stated by rulemaking that unpriced codes would be handled by crosswalk/gapfill.  (CMS admits it already has a regulation to follow: at 42 CFR 414.508(b)(1-2).)  (E.g. see letter from AMP to CMS, here.)

CMS states that detailed agenda will be posted about a week ahead of the September 25 workshop.  Presentations must be submitted to CMS by September 21 at 5 pm ET.