Will deletion of the molecular diagnostic ‘stacking codes’ provide the solution?
Yes, deletion of the ‘stacking codes’ does lead the way towards added transparency in the billing of common molecular genetic tests, but…
Since the AMA’s announcement of the new Tier I Gene Analysis & Tier II Molecular Pathology CPT codes in 2011, there has been continued speculation regarding the future of laboratory billing for molecular genetic tests. The current methodology for billing genetic tests are the procedural ‘stacking codes’ leaving payors with very limited visibility into what tests were actually performed. With CMS’s decision not to incorporate the new codes in 2012, consequently no fees were assigned, what were the commercial payors to make of these codes? How would the laboratories react to these new codes? When and would the payors require utilization despite CMS’s position? An enforcement trigger was blatantly absent, therefore nothing happened. This month the AMA released the 2013 CPT manual, and there in Appendix B the trigger event was present…the deletion of the infamous procedural ‘stacking codes.’ Also this month, CMS announced the November release of payment determinations for ONLY clinical diagnostic tests which will be paid under the Clinical Laboratory Fee Schedule (CLFS.)
Deletion of the ‘stacking codes’ with added CMS payment determinations will certainly provide the added means for improved utilization and claims management. However, issues do still remain! What about fees for hereditary tests? Given that labs cannot self-assign genes, do the Tier II codes provide for an absolute repository for the billing of all other genetic tests? Then there is the added ‘catch all’ CPT: 81479 – ‘unlisted molecular pathology procedure’.
Just today, NCBI lists 626 laboratories testing for 2770 diseases. http://www.ncbi.nlm.nih.gov/sites/GeneTests/
We are in the midst of revolutionary changes in the reimbursement of molecular and genetic tests. However, the question remains, can the AMA and CMS ever stay ahead or at a minimum keep pace with the rapidly evolving world of molecular genetic testing? Is there a better solution? And if so, what?