Health Information Management

Tip: Note molecular pathology changes in MPFS

APCs Insider, January 25, 2013

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Over the past two years the AMA has made significant additions to the molecular pathology CPT codes, which first appeared in the 2012 book and are expanded in the 2013 CPT® Manual.

CMS will pay for the new molecular pathology CPT codes under the Clinical Laboratory Fee Schedule (CLFS) instead of the Medicare Physician Fee Schedule. This issue has been under great debate for the last two years, which is why CMS in CY 2012 continued to allow hospitals to report existing "stacking codes." That changed as of January 1, when the stacking codes will be deleted and replaced with more than 115 new codes that will be paid under the CLFS.
 
The new molecular pathology codes, while significant in terms of the number of codes, are actually simpler than the stacking codes, which were very difficult for hospital systems to operationalize.
 
 
 
The tip is adapted from “CMS finalizes changes to drug payments, relative weight calculations” in the January Briefings on APCs.



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