Friday, June 21, 2019

Very Brief Blog: CMS Posts Final Agenda for Annual New Lab Codes Pricing Meeting

Each summer, CMS holds a public meeting for comment on how it should price each of the new lab codes for the coming year (e.g. CY2020).   CMS has posted the final agenda for the Monday, June 24, 2019 meeting, with 40 public presentations calendared.  There are about 100 new codes in total, most of them PLA codes aka Proprietary Lab Analyses.  PLA codes are issued quarterly by AMA.

  • See the main CMS webpage here.
  • See what's new - the 3 page PDF of the final agenda - here.
  • See the Excel spreadsheet of all 95 individual codes by name - here.

The meeting begins at 9 and public presentations run to 345 pm with a lunch break.  CMS states that each presentation will be up to 10 minutes (I tally about 8m15s by dividing the time by the presentation list).


The meeting will be webcast on YouTube.  It's uncertain if it will also be archived.  The Summer 2017 meeting was both webcast and archived; the 2018 meeting only webcast.  See info on page 1 of the agenda.

Auto Chem Panel Policy

The day will close with a 15 minute presentation on "automated chemistry panel" policy 3:45-4:00 with "open dialogue" or discussion to 5:00 pm.  Parties may sign up early in the morning "if they would like to read a prepared statement."   CMS released change release 11248 on May 3, 2019, regarding "re-implementation" of certain edits related to chem panels (here).  The instruction is backdated effective to January 1, 2019, because CMS is implementing instructions it released as part of CY2019 CCI edits in November 2018.  For more on the panel pricing controversy, GAO report here.

Professional Laboratory Advisory Panel July 22-23, 2019

Note that CMS's panel of advisors on lab test pricing and policy will be meeting on July 22-23 to discuss the pricing of all these codes, too.  Here.

CMS releases draft prices around September 1, triggering a new comment period, and final prices by November.