Health Information Management

Pay-per-view: Molecular pathology reimbursement still unclear

APCs Insider, May 10, 2013

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The AMA revised the molecular pathology codes in the CPT® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them.

While CMS did not change payment for these services under the Clinical Laboratory Fee Schedule despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.
In the past, facilities reported stacking codes for molecular pathology, meaning they reported a different code for each step of the procedure required to perform the test, rather than being able to report the actual test (e.g., KRAS) that was performed.
Continue reading Molecular pathology reimbursement still unclear on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the May issue.

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