Thursday, July 27, 2023

Very Brief Blog: CMS Posts Advisory Panel Rec's for Pricing New Lab Codes

NUTSHELL:  CMS posts Advisory Panel votes for prices of 85 new lab tests.


Every summer, CMS holds a series of meetings and events regarding the pricing of new lab codes for the next calendar year.  On July 19, 2023, CMS held its panel of expert advisors who voted on a price or alternate prices for every new lab code.

Here's the web page for the panel:

Here's the newly released PDF showing every vote on every code.  Many votes are unanimous but some codes get a variety of voting choices and price choices.

Gapfill Recommendations?

Last fall, CMS sent about 40 of 100 possible codes into the gapfill process (the gapfill process that is active with MACs currently, this year).

The CLFS advisory experts only voted majority-gapfill for about 13 of 85 codes.   Of these, only 8 of 85 codes had a strong majority vote for gapfill (such as 8 votes or 9 votes out of 9 voters).

None of the codes the panel voted for gapfill, were conventional PCR MAAA tests (e.g. mRNA expression for 20 genes).  

A single lone panelist voted for gapfill (1 vote) on 9 codes. 

Event Horizon

June - Public comment meeting (live streamed)

July - Expert panel advisory meeting (live streamed)

1H September - Proposed Prices

2H September - Comments

November - Final Prices

After final prices, an appeal can be filed, but it basically just brings the code back to the same meeting the next summer again.