Tuesday, April 3, 2018

CMS Releases New AMA CPT Lab Codes for CY2019 (Gearing Up For Crosswalk Meeting)

See April 30 Update with a total of 81 items.
At this webpage, here, look for "List as of April 30, 2018" File


At the end of March, CMS announced the annual new lab test public meeting for pricing would be June 25, and a national webinar for the lab advisory panel would be July 16-17 (here).  Registration for the June meeting opens on April 4 on the CMS CLFS website; for presentations, powerpoints are due June 11.

On April 3, CMS posted the new AMA CPT lab codes for CY2019.  See the CMS home page for the annual meetings and scroll to the bottom for "CODE UPDATES" and "CY2019."  Here.  You'll get an excel spreadsheet. 

Don't be surprised if CMS updates it from time to time, however.

  • I  am pretty sure this list is NOT COMPLETE, as it includes 
    • two "reconsidered" codes (81334 RUNX1, leukemia; and 81326, PMP22, myelin, Charcot-Marie-Tooth; see below), and 
    • 27 PLA codes, and 
    • 3 "Administrative MAAA" codes (0011M, 0012M, 0013M).    
  • Today it includes "zero" regular Category I new codes.
  • Over the past year, AMA CPT has also generated a number of regular Category I CPT lab codes for CY2019 (I think > 50).
  • I assume the CMS spreadsheet will be updated with those at some point.  
    • See the rolling releases of CPT actions in recent quarters here.
Here comes my informal list, from various AMA actions, of 2019 Cat I Lab CPT Codes that I don't see on the initial CMS code list.  There may be as many as 54 new Cat I lab CPT codes, driven in part by the 30 new Triple Repeat codes.

If I'm correct, the meeting will be handling the 32 new codes (PLA, etc.) already released by CMS plus another 50-odd new Cat I lab codes, or a total count in the 80s.

My informal count of new CPT lab codes for CY2019

Reconsidered Codes: 81326, 81334 (PMP22, RUNX1)

Last September and November, CMS announced its preliminary and final crosswalks for these two codes.

81326 is "Known familial variant" for PMP22 (Charcot Marie Tooth).  Commenters recommended crosswalk to 81215, BRCA1 known familial variant.  Based on PAMA data, this known variant test is priced quite a bit higher than most other known variant tests ($375). 

CMS crosswalked instead to the 81322 PTEN known familial variant ($53).    CMS stated tersely, "We disagree with the crosswalk to 81215 because we believe that crosswalk to 81322 appears to be a similar type of test (methodology, gene analysis, known familial variant) to code 81326."   Of course, by itself, this explanation doesn't distinguish between the choices at all, both are gene analysis of known familial variant.

81334 is targeted sequence analysis exons 3-8 of RUNX1, used clinically in leukemia.   Panel recommended 2x81235 (EGFR common variants).  Another proposal was 1.5x81272 (KIT exons 8,11,13,17,18).   CMS chose the KIT crosswalk but said "there was insufficient rationale for a 1.5 multiplier."