Wednesday, April 17, 2019

Update: CMS Posts First Code List for June CLFS Crosswalk Meeting

In late March 2019, CMS announced its annual summer new lab test pricing meeting for June 24.   See the full discussion at my post a few days ago, here.

On April 15, CMS posted a code list of codes to be discussed.   Comments and participant registration are due by June 10 (see prior link).

3+3+41=47 Codes To Be Discussed

CMS posted three codes under reconsideration - BRCA1-2 code 81163, BRCA-1 sequence 81165, and 0046U, a tyrosine kinase gene.

CMS posted only three new regular pathology codes, 813X1 (PALB2), 813X2 (PALB-2 family variant), 8XX01 (PIK3CA, targeted analysis).   There seem to be no new non molecular lab codes, if this list is complete.

Finally, CMS posted a bonanza of 41 PLA codes, including those approved in Q12019.

Will CMS Add May 2019 PLA Codes?  Like Last Year?  Past as Prologue?

Last year, the late June CMS CLFS meeting included those PLA codes approved in early May 2018 by AMA. 

We expect that AMA will be approving about 30 PLA codes this year in early May, so it is quite possible, but not certain, that in late May CMS will add them to the June 24, 2019 agenda.   CMS needs to receive the May 2019 codes from AMA in time to post 30 days in advance of June 24, 2019.

Download the Spreadsheet

Go to the CMS CLFS Public Meeting Page, find CY2020 code list near the bottom.

2019 Gapfill Process

CMS has about 18 codes under CY2019 gapfill process, with prices being set this spring by MACs.  CMS should post proposed gapfill prices in April or May or June.  Here (see bottom section of that blog for gapfill roster).