There aren't surprises; CMS is implemented PAMA cuts released in November 2017 for CY2019, and CMS is releasing gapfill pricing or new code crosswalk decisions that had been posted in recent weeks.*
Find the fee schedule here.
BRCA
New codes and pricing become effective January 1 related to BRCA testing, as shown in this table:
Gapfill
18 codes are under the gapfill process.
___
Tidbits.
New code for inherited disorders panel, pan-ethnic, 81443, is the same price as Ashkenazi disorders panel, 81412 ($2448).
The CLFS has 2,015 lines, although some lines are duplicates with and without a QW CLIA waiver suffix (which doesn't change pricing, but allows the code to be paid outside a CLIA lab). If you ordered every test once, it would cost $232,665.57.
The least expensive test is 81005, urinalysis, $2.41. The most expensive is family member exome sequence (81416, $12,000) which logically should not be more than proband exome analysis (81415, $4780). 31 tests are over $2000.
As the result of gapfill pricing in recent months (over 20 stakeholders commented to CMS on this topic), whole genome sequencing is $5031 (81425), $2709 (81426 for family member), and $2337 (81427) for re-analysis.
After one of the longest journeys I have followed, and several years of changing prices at CMS, and a gapfill year, Sep9 landed at $192 (81327). This represents the FDA-approved Epi proColon test.
___
* I haven't manually checked if any proposed final gapfill prices from October 2018 have altered.
