I wrote a blog a few weeks ago on the pending, 2024 Medicare gapfill lab pricing process (here).
In a typical year, around Feb 1, Novitas-FCSO post a web portal for info, and NGS MAC posts an email info address and deadline. (MolDx doesn't post anything, but I always tell labs, if you're in gapfill, and MolDx can't find you and contact you by Feb 10, you reach out to them with your contact info).
NOVITAS has posted its online process for 2024 gapfill info. Find it here:
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00246106
The 29 codes under 2024 national gapfill pricing are:
- 81457, 81458, 81459, 81462, 81463, 81464, 87467
- 0019M, 0329U, 0334U, 0356U, 0361U, 0364U, 0368U, 0379U, 0381U, 0382U, 0383U, 0388U, 0389U, 0395U, 0396U, 0398U, 0399U, 0400U, 0401U, 0408U, 0412U, and 0417U.
Novitas Deadline is March 15, 2024.
Of special interest to all molecular pathology labs will be the MolDx pricing info and decisions for new AMA CPT codes for liquid biopsy and other types of tumor genomics.
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NGS MAC also publishes its rules, which are submission via an email box by March 1, 2024.
Nerd Note
Because CMS sets a median price [essentially] by state, and MolDx has a majority of states, the MolDx gapfill price is always "the" permanent gapfill price when the process concludes.
Nerd Note and AI Pic
I wrote a 2020 white paper on the in's, out's, and ambiguities of the gapfill process. Nothing has changed since then; it's equally current for 2024.
https://drive.google.com/file/d/1eDVJ2mvpQAUlZ-NY6YJwSyXZJsbigyus/view
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