Friday, August 21, 2020

Very Brief Blog: CMS Posts Results of PAMA Expert Advisory Panel for New Code Pricing 2021

Each summer, CMS posts all new PLA and CPT codes for lab tests, towards pricing the next calendar year's fee schedule.

This year, held its public comment meeting June 22.  

CMS held its advisory panel meeting July 29-30, and I posted an unofficial transcript at the time here.

  • Now, in August, CMS has posted the voting results of the advisory committee - here.
  • CMS posted as a PDF; I've also posted a conversion to Excel data format - here.

Quick Insights

Whether voting for gapfill or for a specific code crosswalk, it appears the committee voted more uniformly on a single choice for each code, than in past years. 

I tallied 45 codes that were majority votes for gapfill (7 or more votes).  

Fractional crosswalks, though often requested by public stakeholders, remain unpopular with the panel.  For example, for a drug assay code 0143U, the stakeholder hoped for 0082Ux1.3, which got 2 votes, while there were 9 votes for gapfill.  Code 0202U, a viral panel including COVID, requested a crosswalk to (87631 + 87798x4 + 87502, but got 11 votes for a much simpler crosswalk to 87633.

There were two psychiatry gene panels, 0175U (8 votes to crosswalk to 0078U and 4 to gapfill), and 0173U (11 to gapfill).    

A block of codes 0156U-0162U had almost a clean split between single crosswalks, and gapfill, for each code.

Advisory Panel Votes for COVID Codes

COVID Votes - Click to Enlarge

My Excel in cloud of advisory votes for COVID codes here.

U0001, U0002 had a couple votes for "crosswalk to themselves" but they're not on the current 2020 fee schedule.  On the other hand, U0003, U0004 are literally already on the CMS fee schedule already, so they could be crosswalked to themselves.

What Happens Next

CMS will release its proposed decisions for public comment in the first half of September.  Using last September as a guide, CMS disagreed with the summertime majority panel vote a significant proportion of the time (maybe 20% or so).