Friday, July 23, 2021

Very Brief Blog; CMS Posts Agenda for July 28-29 Lab Expert Pricing Meeting

Find an unofficial 140-page transcript of the two-day meeting here.

I apologize that Hour 2 and Hour 3 of Morning 1 are missing from the transcript.

CMS should post voting scores by mid-August, I think.


Every summer, CMS has meetings to assist the agency in pricing new lab codes for the subsequent January.   CMS held a public comment meeting in June, and will hold an expert panel advisory meeting on July 28-29, 2021, which will be viewable by Zoom.

The agenda has been posted here:

The meeting is scheduled to run from 9 am to 430 pm on Wednesday, July 28 and Thursday, July 29.  Based on past experience, the time alloted to any given code can very unpredictably and by large amounts.  CMS posts a planned agenda in 2-hour increments and published a panel item list of 101 items.

The panel has about a dozen members and is divided into four subgroups A,B,C,D, each of which reports on detail on about 25 codes, although all the panelists vote on all the codes.  I am guessing that each panels understands his/her set of 25 codes and the pricing alternatives quite well, but deals with the other 75 codes mostly by the agenda-item presentation of each code and recommendation by its workgroup.  The public doesn't have any comment rights but panelists may ask a code sponsor for a clarifying answer.

CMS often takes the panel decision, or at least considers it, but the panel is only "advisory" to CMS.  CNS has been classifying nearly half the codes as "gapfill" in the past couple years, meaning the pricing decision is left to MACs in the following calendar year.


On a personal note, a code I am involved with as a consultant was in the first ten items in June, but is in the last ten items this time around.