Monday, November 20, 2023

CMS Posts Final Prices for New Lab Codes CY2024

CMS has posted final prices on new lab codes for CY2024.  .

What Happened?

By my informal tally, there are 84 agenda items.  13 changes.   

10 changed from a crosswalk recommendation to a Gapfill, and 3 changed from gapfill to crosswalk or from one crosswalk to a different one.  WIth the 10 new Gapfills and a couple gapfill "losses," I tally 30 codes for the 1H2024 gapfill process, out of 84.

6 New CGP Codes Get Gapfilled, Not $600

In likely the most-watched codes, CMS had proposed that 6 new AMA CPT comprehensive genomic profiling codes (CGP) be priced at about $600 (CW 81445).  All 6 of those $600 crosswalks met with strong complaints, and CMS has split the difference by turfing them to the 2024 gapfill process.   (This story got a 12/14/23 article in Genomeweb.)

3 Slide-AI Codes All $700

There were 3 codes for AI-enhanced slide-based imaging, 0376U (Artera AI Prostate), 0414U (former X084U, LungOI Imagene), 0418U (former X088U, PreciseDX Breast Bx).  Requested prices were as high as the $2500 range (Artera request).   

The expert panel, the CMS proposed  price, and the CMS final price were all crosswalk to 0220U (PreciseDx Breast) at about $700.    (I've noted earlier that if you views "slides + AI" as a category, prices have reached as high as $5435 for ADLT pricing of the Prelude DCISioniRT test 0295U).  Labs in this group can appeal, meaning the price would be revisited next summer.

Crosswalk = Crosswalk to 1 Code

Of about 56 codes crosswalked, all but 4 were crosswalked to a single target code.  One was crosswalked to a 0.5 fraction, and three were crosswalked to addition of 2 or 3 codes.

Read For Yourself

Find the new final spreadsheet at this link.  Scroll down for Agenda and Announcements, and find a Zip file link for CY2024 final prices.