CMS Updates 2015 Gapfill Spreadsheet: Oncotype DX Now $3416 not $2900

On September 25, CMS released a spreadsheet of final CY2015 gapfill prices from its MACs, which listed Oncotype DX Breast at a price (beginning January 1, 2016) of $2900.  This was the median price of a small number of MACs reporting.

On October 7, CMS updated the spreadsheet.  The new spreadsheet lists Oncotype at $3416, and the change was caused by Noridian entries (which were previously blank) now being filled in at $3416.



GHDX issued a press release, clipped below.

In an earlier blog, I had wondered whether CMS had miscalculated the median based on applying "median" to states rather than MACs (here).   CMS continues to calculate the median of "states" but now that median is $3416, since Noridian has so many states.  I still think CMS regulations point toward use median of MACs, not median of states, but it is a moot question here since both methods give the same answer now that all the Noridian states are added to CMS's spreadsheet.

October 7, 2015

CMS Increases Final Pricing Determination for Oncotype DX® Breast Cancer Test to Previously Established Rate of $3,416

REDWOOD CITY, Calif., Oct. 7, 2015 /PRNewswire/ -- On Tuesday, October 6, 2015, the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, issued updated pricing determinations for the Clinical Laboratory Fee Schedule (CLFS) including a payment rate of$3,416 for the Oncotype DX^® breast cancer test.  This is the same rate paid by Noridian Healthcare Solutions, the Medicare Administrative Contractor (MAC) who processes Genomic Health's (Nasdaq: GHDX) claims.  This means the payment rate for the Oncotype DX breast cancer test will remain at the current contracted rate of $3,416 through 2016.  In 2017, market-based rates under the Protecting Access to Medicare Act (PAMA) are expected to replace the current Medicare CLFS.
"We are pleased that CMS quickly revised its final pricing determination for the Oncotype DX breast cancer test to reflect the MAC-established rate as well as the factors set forth by Medicare to establish payment amounts, such as market rates and resources," said Kim Popovits, chairman of the board, chief executive officer and president of Genomic Health.