Thursday, May 13, 2021

CMS Announces Dates for Summer New Lab Code Pricing Meetings (June 24, July 28-29)

Each summer, CMS holds two meetings to collect information on how to price new laboratory test codes for the coming calendar year (here, 2022).

Here are the links, and I've put the key documents in one ZIP file in the cloud as well.

  • CMS webpage for the public comment summer meeting here.
    • CMS Federal Register announcement of the June 24, 2021 public meeting here.
    • Publication May 3, 2021, 86 Fed Reg 23886-9 (4pp)
    • Comments due to CMS by June 3; registration required.
    • CMS comments that registration is first-come first served.
    • CMS Excel file of CPT codes to be considered here.
    • Note that the Zip file may be updated and the link changed.
    • See CMS webpage for newer links.
    • >> One of my clients and I found a substantial typo in our code name, so don't assume correct CMS transcription.
  • CMS webpage for the advisory panel meeting here.
    • CMS Federal Register announcement for the July 28-29 meeting, here.
    • Publication May 3, 2021, 86 Fed Reg 23885-6 (2pp).
    • The public doesn't submit comments, but can watch the panel.
  • My own ZIP file (one stop shopping) of the key documents as of May 13, cloud, here.
What Are The Codes?

As of now, CMS posts 53 codes, of which 6 are reconsiderations, and 47 are new.  

27 of the 47 new codes are PLA codes.

Note that CMS is likely to add PLA codes coming out of the April-May AMA CPT cycle, as well as new Category I codes coming out of the May 7-8 AMA CPT meeting.   In past years, CMS has always quickly added the May AMA CPT codes to the June pricing meeting.   CMS is supposed to publish the final agenda for the June meeting 30 days in advance, e.g. by May 25.  Check for updates.

COVID Codes In Play

Ten new COVID codes are up for pricing discussion, including 4 category I COVID codes.   

Note that some major COVID codes are currently in the CY2021 gapfill process.  CMS will post the MAC gapfill prices for these COVID codes sometime between May and August for 60 days public comment.