This year, there's a tsunami of new Alzheimer codes, both in the CPT Category I group and in the PLA group. I've made a chart which I think is comprehensive and correct, but I only offer as "my best effort."
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Update. While new articles appear constantly, Schindler et al. is a new one, finding P217Tau is the best of 6 markers. It's covered in 360Dx and published at MedRxiv pending publication in Alzheimer & Dementia (journal).
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From top to bottom, there were two PLA codes assigned a price last year, Fujirebio FDA CSF test at $260 (0358U) and Quest Amyloid Plasma at $94 (0346U). But note, in July, CMS published PLA code applications for comment, and it includes a proposed deletion of 0346U.
In the next section, two PLA codes are in gapfill. Proposed prices were released in the spring, and final prices in the fall. These are 0361U, light chain neurofilament from Mayo, proposed gapfill at $17. 0412U, the amyloid plus ApoE Precivity test from C2N, proposed gapfill at $339.
In the final section, we have the active crosswalk process, where the big news will be the proposed CMS prices in September 2024.
In the meantime, we have the votes of the federal advisory expert panel. Basically, they proposed the 10 new Alzheimer codes (5 AMA and 5 PLA) to be priced either at one half 0358U ($130) for 1 biomarker, or at $260 for 2 or more biomarkers.
New CPT Category 1 codes will be released in October for Beta 1-40, Beta 1-42, Tau Phos (any), Total Tau, and NF light chain.
New PLA codes will be released for NF light chain (Wash U), two different Beta42 & Tau tests from Roche, the phospho Tau 217 test from Alzpath, and finally the second-generation Precivity AD2 test from C2N, which has a beta amyloid ratio and a tau percent phosphorlyated ratio. Several major position papers have touted the accuracy of phosphoTau as the best single test, including the guideline this summer of Jack et al. The AD2 next generation C2N test just got big press in a JAMA study by Palmqvist that garnered at least two favorable op eds.
Click to enlarge.
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Google sheets version here.
The original posting had an incorrect and too-low panel crosswalk for 0503U (C2N). The correct panel vote is 0384U $750 for 0503U.
