Monday, October 30, 2023

And Then There Were 12: Proliferation of AMA CPT GSP (Tumor) Codes

 From about 2014-2022, genomic sequencing procedures for tumors were so simply many of us had the codes memorized.  There were only 3.   81445 was for solid cancers 5-50 genes, 81450 was for heme cancers 5-50 genes, and 81455 was for any cancer, 51+ genes.   The two small codes were around $600 and the big code was around $3000.   The situation was complicated for records review and public health publications, since in 30 states, MolDx used 81479 (unlisted code, "other test") instead of 81455.  But for AMA CPT, just 3 codes.

This complexified in CY2023, when AMA created an additional code for "RNA only" studies.  (The original codes remained DNA, or DNA+RNA).   To me, this encouraged people to bill the 50 DNA genes on Monday and 50 RNA genes on Tuesday, but let that lie.  

Now for 2024, AMA has raised the total codes to 12.   They've added three more variants for cancer procedures if add-ons like MSI or TMB are used.   They added three variations of codes for liquid biopsy (previously, there was no call-out for LBx tests).   

CMS has proposed all 6 of these codes be crosswalked to 81445 (about $600) for 2024.  But CMS won't issue final prices til late November, so we'll be watching that.    None of these six new codes (for 2024) have a gene count mentioned.

UPDATE:  This crisis of underpricing covered in a subscription article at Genomeweb/360DX by Kelsy Ketchcum on November 8, here.  My updated blog Nov 9, here.

In the 2024 codebook AMA CPT publishes a table of the whole big menagerie. Click to enlarge.

Get the AMA 2024 CPT code book from Amazon, AMA, or other sources.  It's now 1283 pages.

click to enlarge