Sunday, January 2, 2022

Very Brief Blog: CMS Releases Lab Fee Schedule for January 2022; AMA Releases new PLA codes as well

This blog has two sections, #1 - CLFS Spreadsheet released, and #2 - New AMA PLA codes released.

#1 - CLFS Spreadsheet CY2022

CMS has released the lab fee schedule for January 2022.  This includes new codes priced by CMS by the crosswalk method in 4Q2021, and lab codes priced during the past year through the gapfill process.   

Normally the fee schedule comes out in November for January, but it was delayed due to pending Congressional bills regarding PAMA pricing and their impact on CY2022.  (Explanation here.)

Find the Excel spreadsheet here:

The fee schedule has 1,859 active lines for codes.   5 are "U-prefix" codes, all CMS covid codes.   13 are "M" codes, or MAAA administrative codes.  287 are "U-suffix" or PLA codes.   I codes run up to 0305U, suggesting that about 18 of the first 305 codes have been deleted.  There are 291 codes in the regular Category I genomic codes series (about 81105 to 81595).  I tally 60 with the "L" or local designation, which are usually codes in the formal gapfill process or else brand new quarterly PLA codes that have not begun any pricing process.

In any category - regular codes, PLA codes, etc, a minority of codes get most of the utilization (here).

Gapfill Appeals

CMS takes appeals (reconsiderations) of its final gapfill prices, which were issued in September for about 53 codes.  No gapfill prices changed between the Gapfill Final spreadsheet and the January 2022 fee schedule.  CMS doesn't release any information on whether one or more appeals were filed, but if they were, the price did not change.   I noticed that gapfill code, 0208U, mRNA analysis of 109 genes, Veracyte Medullary Thyroid Classifier, MTC, disappeared from the January fee schedule.   I see AMA lists 0208U as being deleted effective January 1, 2022 (here).  How "Veracyte MTC" is currently coded wasn't obvious to me (it didn't jump out at me from the 2022 code book).  

Standard CLFS Transmittals

CMS has released its Transmittal for the CY2022 CLFS, here, being CR12558, T11151, dated December 10, 2021.  It doesn't include a listing of specific gapfill codes, so CMS may revise it.  Last year the CY2021 CLFS transmittal, here, CR12080, included a several page listing of gapfill codes, but was dated later, on January 20, 2021. 

#2 - AMA PLA Codes

Similarly, AMA has just released the latest batch of quarterly PLA codes.   Find them here:

Codes 0306U-0322U are being announced for the first time December 30, 2021, and effective April 2022.   We also have codes 0285U-0305U which were announced on October 30, 2021, and are now effective as of January 1, 2022.  (Codes 0306U forward, will appear on the April 1 second quarter CMS fee schedule with no process, flagged for local pricing as "L".)