UPDATE: FRIDAY, 5/26, CMS RELEASED THE EXPANDED AGENDA w/ MAY CODES.
This adds codes from the May 2023 AMA CPT meeting. This includes several for Acetylcholine receptor antibodies, a muscle-kinase antibody, and Hep D quantification. Plus, 18 PLA codes, plus one Admin MAAA code (---M).
At CMS, you might have to refresh or reboot your browser to "see" the updated 5/26 file at the far bottom of the web page.
The Lab Pricing Public Meeting
Every summer, CMS holds "Crosswalk/Gapfill" meetings to assist it in pricing new lab tests. This year, the meeting is Thursday, June 22, 2023, public comments due June 1. The meeting does not require registration and is streaming-only, unless you want to submit a public comment and register to speak.
April Agenda Versus Bigger, Last-Minute Agenda
For years, CMS publishes the test code agenda twice. One version comes out around May 1, and includes codes passing AMA review through the first quarter. Then a second version comes out, sometime circa June 1, which includes last minute codes finalized by AMA in early May.
The April Agenda Assessed
CMS issued the prelimary agenda on April 27. I missed it because it is at the far-bottom of the relevant webpage. Here's the link to the webpage, scroll to the far bottom, and see the 2024 code list. (I'm giving the way page rather than a specific link, to allow for unpredictable CMS updates).
At this web page, click on the meeting notice heading, and then ALSO when that opens, scroll to the far bottom.
In this April 27 version, there are 64 items.
- RECONSIDERARTION OR REVISIONS
- Six PLA codes submitted for reconsideration. Four are items 1-4 - 0326U, 0324U, 0348U, 0350U. Later, items 39 and 41 are also reconsidered PLA codes (0329U, 0334U).
- One regular CPT code is also reconsidered, 87467, microbiology, HepB SAg, quantitative.
- Two PLA codes are on the agenda for "substantial revisions" which are 0022U and 0095U.
- NEW CODES
- NEW PLA codes run from 355U to 401U.
- Again, we would normally expect CMS to add a couple dozen last minute PLA codes around June 1.
- There are 8 new Category I PLA codes.
- 2 of them are not genomic. 8X016 is anti mullerian hormone chemistry, 8X025 is liver disease, 3 biomarkers, risk score.
- 6 of them are genomic sequencing procedures. 3 are for solid organ sequencing, 3 are for solid organ sequencing specifying liquid biopsy (cell free nucleic acid).