This year 18 codes are in the Gapfill process, with comments accepted to July 13, 2026.
Find the spreadsheet at the CMS CLFS webpage, scrolling down to Gapfill proposals.
What's Up/
There were only 2 codes of 18 where MolDx and Novitas prices aligned (0420U, 0569U).
But there were 8 of 18 where MolDx and NGS MAC aligned.
Biggest Oddities
I counted 9 codes where, to my eye, there were substantial differences among the MAC prices.
For example, for 0552U, MolDx was $1160, while Novitas was $164 higher and NGS MAC was $835 lower.
Two codes were really bizarre. For 87182, MolDx was $9.65 and Novitas was $4 higher. But NGS MAC was $640 higher than that. ?!?
For 0594U, MolDx was $12.05 and Novitas was 42 cents higher. But NGS MAC came in at $2498 higher than MolDx.
The nine codes with wide variances at one or two MACs, relative to MolDx and its Median, are shown in the table below. Click to enlarge. Find a Google Sheets version of my work here, note it has multiple tabs.
As in past years, the required "rationales" are usually boilerplate (the same for every result).
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| click to enlarge |