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Pathology/Lab Coding Alert

Molecular Pathology Payment:

Wait for Gapfill to Learn Your Molecular Pathology Pay

Published on Tue Oct 09, 2012

CMS indicates CLFS, perhaps some MPFS pay.The Clinical Lab Fee Schedule (CLFS) is for molecular pathology code payment, according to the CY 2013 CLFS preliminary payment determinations posted by CMS on Aug. 31 (www.cms.gov/ClinicalLabFeeSched/). With some industry heavy weights recommending payment on the Physician Fee Schedule (PFS), labs have been waiting to see what CMS would do. Now the decision is in -- CMS will use gap-filling to price the codes on the CLFS.Rewind: CPT® 2012 added 101 new molecular pathology codes, but CMS declined to price the codes for CY 2012 due to "stakeholder debate whether Medicare should pay for the molecular pathology tests under the CLFS or the PFS," according to the agency. Now CPT® proposes 13 new Tier 1 molecular pathology codes for 2013, as you can see in Table 1. With a greater number of CPT® molecular pathology codes for 2013 and the [...]
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