Bulletin: September 7, 2012
CMS Recommends Preliminary CLFS Pricing Method for Molecular Pathology Procedure Codes
On August 31, the Centers for Medicare & Medicaid Services (CMS) announced that it recommends using the gap-fill methodology for pricing new molecular pathology procedure (MPP) codes on the 2013 Clinical Laboratory Fee Schedule (CLFS). The final pricing method decision will be announced in November.
CMS is recommending gap-filling because it feels there is not enough information on the new molecular pathology procedures to use the crosswalking method, i.e., matching an MPP code to an existing code or codes to determine the appropriate payment rate. Because CMS did not receive sufficient information on how to match MPP codes to existing codes, it recommends that local contractors “fill the gap” and set the fees for 2013 based on local pricing patterns.
The gap-fill method would apply only to the MPP codes that CMS determines should be paid under the CLFS. This leaves open the option to price some of the MPP codes on the Physician Fee Schedule, despite CMS’s July proposal to price all new MPP codes on the same fee schedule.