February 2012 Newsletter
AMA Begins Advancing Molecular Pathology Procedure Codes
The American Medical Association’s AMA CPT 2012 codebook introduces over 100 new molecular pathology procedure (MPP) codes designed to replace “stacked” multiple CPT coding in favor of a single test-specific code. The new MPP codes, which were developed over several years of planning by the AMA’s Molecular Pathology Coding Workgroup (MPCW), hold out the promise of vast improvements in laboratory reimbursement from the vantage point of both Medicare payers and testing facilities. The College of American Pathologists (CAP) has called implementing the codes a “tremendous cooperative undertaking by the entire healthcare industry.”
While publication of the codes marks progress, it also raises important questions about the phase-in process—particularly with respect to reimbursement. For 2012, the Centers for Medicare and Medicaid Services (CMS) has elected not to assign prices, or Relative Value Units, for the codes. Instead, the CMS has requested that labs include both conventional “stacked” codes and the new MPP codes on Medicare claims. The new codes are indicated for non-payment by a “B” indicator. However, the CMS is asking labs to submit estimated charges with the codes to help establish pricing.
The CAP and other laboratory groups have urged the CMS to release the list of Relative Value Units for the new procedures that was developed as part of the workgroup. Without Medicare prices available, non-government payers are unlikely to begin using the new MPP coding methodology.
Eventually, the MPP codes published this January will encompass over 90% of the molecular test procedures currently being performed and within the MPCW’s jurisdiction. The workgroup settled on a two-tiered approach to coding MPPs. The 2012 codebook includes approximately 90 Tier 1 codes, which are test specific, based on the analytes (genes/gene variants) tested, and cover the vast majority of MPP services performed today. A second category, Tier 2 codes, is based on the resource levels involved in testing and can be used to code less common tests. In total, the MPP subsection spans codes 81200 to 81408 in the updated CPT manual.
For updated information on how the MPP codes will impact laboratory reimbursement, check future issues of Q-Tips and bulletins on the Quadax Web site.