Each fall, CMS assigns a couple dozen new lab test codes to be priced by gapfill. It transmits to each MAC a list of codes for which the MAC's gapfill will be requested.
MolDx MACs generally have not made any public posting of this. (MolDx has stated at public meetings, that it reaches out to stakeholders as needed to do its gapfill work.)
Novitas/FCSO MACs generally make a public posting and a web portal for data submission. That's now up, for 2025. Data is requested by February 28, 2025. See the web page:
https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00246106
Novitas provides a cost-COGS template. They also provide a web portal with different questions.
click to enlarge. Novitas. |
NGS MAC also has a public posting:
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CMS posts final decisions on about 100 new codes in late November (blog), some of which decisions state "gapfill."
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I understood from some emails that early MAC GF lists may have had some errors but hopefully that's resolved.
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MACs give their gapfill data to CMS in mid-spring, CMS publishes online, requests public comment, and final MAC gapfill prices appear in the fall.
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CMS sets prices at the median more-or-less at 'state" level, so MOLDX, with 28 states, always controls the median result.
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