CMS Signals Clinical Lab Fee Approach For Molecular Test Codes
This article was originally published in The Pink Sheet Daily
The agency did not make any final decisions in a recent proposal tied to its annual clinical lab fee setting process, but CMS gave a sense that at least some of the 101 newly created genetic test codes would be paid for under the lab fee schedule, rather than the physician fee schedule, using the “gap-fill” process.
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How much physician “work” is required for the application of genetic tests will determine how CMS begins reimbursing for more than 100 assays in 2013.
Specific reimbursement codes have been developed for the first time for more than 100 genetic tests, but they will not be adopted by Medicare until at least 2013 as CMS figures out how to incorporate them into the payment system.