COMMENT ON CMS GAPFILL BY AUGUST 7, 2018
CMS has 18 lab codes under the gapfill pricing method and under public comment. Go to the CMS lab public meeting home page here, and scroll down to Gapfill. Submit comments to Mr. Glenn McGuirk by Tuesday afternoon, August 7, eastern time (see email on page). Scroll to the hot link 2018 CLFS Gapfill Preliminary Determinations - Updated 06/13/2018 [ZIP, 17KB] to see the proposed prices under comment.
Probably the most bizarre price is for whole genome clinical sequencing (81425) for which CMS MACs propose $349 payment, although whole exome clinical sequencing (81415) is priced at about $4800. The only thing close to $349 I could find was a price offered by Dante Labs on Amazon.com, and I couldn't find an NPI or CLIA registration for Dante. Concert Genetics has a public website* of lab offerings, many with charges, and typical whole genome pricing was about $7500 per proband or in one case about $18,000 for a trio (infant, two parents, the typical scenario). WGS clearly has some high-profile and impactful use cases now (see Faernes et al., 2018, from Rady Children's Hospital in San Diego; here.).
COMMENT ON AMA CPT LAB CODES BY AUGUST 6, 2018
AMA CPT posts brief titles of pending CPT applications a couple months ahead of each meeting, and you can request a full application (about 20 pages), review it, and comment. The schedule for lab codes runs earlier than all other codes. AMA wanted you to request the applications by August 1, and comments are due August 6. Home page here, PDF of lab codes here. Note that links may change, in which case start from the page I've just listed as "home page."
COMMENT ON AMA CPT "Non-LAB" CODES for SEPTEMBER
AMA CPT has posted the brief titles of all non-lab codes on the same home page for the September 27-29 meeting. For links see here.
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* You can get into the Concert Genetics website and see labs, offerings by test name, and often charges, but you have to do a free email registration (here).
