Saturday, June 1, 2024

CMS Finalizes 130 New Lab CPT Codes for June 25, 2024 Pricing Meeting

In April, CMS set the June 25, 2024 date for this year's public comment meeting on how CMS should price new lab codes.  (Here).  While the public comments, on a CMS powerpoint template, were due May 30, that's about the same day that CMS finalized the agenda of codes, by picking up late-breaking codes from the May 2024 AMA CPT meeting.

Find the code list as a zip file at this CMS page.  Scroll down for meeting announcements and agendas.

The agenda opens with about a dozen reconsidered codes (appealed from last year's pricing).  There follow numbered PLA codes from 420U to 474U.  Not-yet-numbered PLA codes run further, from position 83 to 127.

Noteworthy: Revised Germline Codes; Profusion of New Alzheimer Codes

Among the 130 agenda items, I'd highlight two groups.

Germline Cancer Risk

81432, 18435, 81437 are revisions of three germline cancer risk codes (loosely, one for breast-ovarian, one for Lynch, one for neuroendocrine).   81432 is a decade-old code for heredtiary breast cancer, traditionally paired with 81433 for dup-del analysis.   The code number is struck down from 10 or more to 5 or more (which may block code-stacking of 6 to 9 codes).   The gene list is struck out (it used to be ten genes long including BRCA1-BRCA-2).   If this is priced in the 5-gene range and labs don't bill BRCA inside it, but on another day, it could create a bonus for doing BRCA on a different day (about +$1800).  

81435 continues to say "For Lynch syndrome," but is also rewritten to require only 5 or more genes and the gene list is struck out.   

I don't know if 81433 (dup del) and 81436 (dup del) are deleted because CMS lists only new or modified codes, and does not flag deletions which are not part of the new code pricing meeting.

81437 is a special code for 5 or more genes, neuroendocrine related panel (5 or more genes, no code list).  

Alzheimer Bonanza

Lotsa new Alzheimer codes.

Currently, there's a PLA code for the Fujirebio CSF test (FDA), a Quest blood amyloid test, and a MAAA test that combines ApoE and amyloid.

More neuro codes for 2024/2025:

  1. 0443U, NF light chain
  2. 0445U, Amyloid + tau
  3. 82XX0, Amyloid 40
  4. 82XX1, Amyloid 42
  5. 8X3X0, Tau, phospho (per each phospho position)
  6. 8X3XX, tau, total
  7. XX40U, Amyloid + tau
  8. 83XX0, NF light chain
  9. XX62U, Tau phospho217