Update on Molecular Pathology CPT Codes for 2013
The Centers for Medicare and Medicaid Services (CMS) has released the decision to place the new molecular pathology code on the Clinical Laboratory Fee Schedule (CLFS). CLMA and laboratory groups including AACC, ACLA and others advocated for placement of these codes on the CLFS rather than the Physician Fee Schedule (PFS) given:
- Many of the procedures covered by the codes can be performed without physician involvement;
- Placing these new codes on the PFS would subject them to patient copay;
- Placement on the CLFS maintains the fee schedule that had been in place through CLFS using various stacking codes;
- Placing the new codes on the CLFS will provide consistency if NCDs or LCDs are proposed by CMS or local contractors in the future.
CLMA took a leadership role in our recommendation to recommend using gap fill rather than crosswalk on the CLFS due to the current inconsistency with use of stacking codes for billing and the difficulty that would present in using the crosswalk method to price these procedures. Finally, CLMA was the only organization to recommend the option of an add-on physician interpretation code for any procedures that must have physician interpretation to produce results. We are encouraged that CMS is creating the G code as we suggested.
To see a copy of the final rule, please visit the Federal Register web site at http://www.ofr.gov/OFRUpload/OFRData/2012-26900_PI.pdf