Focus On: Clinical Laboratory Fee Schedule: CMS Gets Pricing Advice for New 2015 CPT Lab Codes

Leading scientific advisory societies and national clinical laboratory groups gathered in Baltimore July 14 to make recommendations on Medicare pricing for new and revised lab testing codes that will be added to the Part B lab fee schedule as of Jan. 1, 2015. Recommendations from four leading organizations — the American Clinical Laboratory Association (ACLA), American Society for Clinical Pathology (ASCP), American Association for Clinical Chemistry (AACC), and American Society for Clinical Laboratory Science (ASCLS) — are listed below.

MEDICARE LAB FEE SCHEDULE FOR 2015: NEW CPT CODES AND PAYMENT RECOMMENDATIONS
CODE DESCRIPTOR	CODE CROSSWALK OR GAP-FILL	PROPOSED NLA
PRESUMPTIVE DRUG SCREENS
801XXX1 Drug Screen	ACLA, ASCP, AACC, ASCLS: Crosswalk to G0434	$19.84
801XX2A Drug Screen	ACLA: Crosswalk to G0431 minus 39% ASCP: Crosswalk to G0431 minus 43% AACC, ASCLS: Crosswalk to G0431	$60.51 $56.55 $99.20
801XX4A Drug Screen	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82491	$24.63
801XXX6 Drug Screen	ACLA, ASCP: Crosswalk to 82489	$25.23
801XXX7 Drug Screen	ACLA: Crosswalk to 82541 ASCP, AACC, ASCLS: Crosswalk to 82492	$24.63 $24.63
DEFINITIVE DRUG ASSAYS
801XY1 Alcohols	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82055	$14.74
801XY2 Alcohol biomarkers; 1 to 2	ACLA, ASCP: Crosswalk to 82055 AACC, ASCLS: Crosswalk to 82542 x 1.5	$14.74 $36.95
801XY3 Alcohol biomarkers; 3 or more	ACLA, ASCP: Crosswalk to 82055 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$16.21 $98.52
801XY44 Alkaloids, not otherwise specified	ACLA: Crosswalk to 82101 ASCP: Crosswalk to 82542	$40.95 $24.63
801XY18 Amphetamines; 1 to 2	ACLA, ASCP: Crosswalk to 82145 AACC, ASCLS: Crosswalk to 82145 x 1.5	$21.20 $31.80
801XY19 Amphetamines; 3 to 4	ACLA, ASCP: Crosswalk to 82145 + 10% AACC, ASCLS: Crosswalk to 82145 x 3.5	$23.32 $74.20
801XY20 Amphetamines; 5 or more	ACLA, ASCP: Crosswalk to 82145 + 20% AACC, ASCLS: Crosswalk to 82145 x 6	$25.44 $127.20
801XY44A Anabolic steroids; 1 to 2	ACLA, ASCP: Crosswalk to 82651 AACC, ASCLS: Crosswalk to 82542 x 1.5	$35.22 $36.95
801XY44B Anabolic steroids; 3 or more	ACLA, ASCP: Crosswalk to 82651 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$38.74 $98.52
801XY28 Analgesics, non-opioid; 1 to 2	ACLA, ASCP: Crosswalk to 82003 AACC, ASCLS: Crosswalk to 82542 x 1.5	$27.61 $36.95
801XY29 Analgesics, non-opioid; 3 to 5	ACLA, ASCP: Crosswalk to 82003 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$30.37 $98.52
801XY30 Analgesics, non-opioid; 6 or more	ACLA, ASCP: Crosswalk to 82003 + 20% AACC, ASCLS: Crosswalk to 82542 x 7	$33.13 $172.41
801XY22 Antidepressants, serotonergic class, 1 to 2	ACLA, ASCP: Crosswalk to 82492 AACC, ASCLS: Crosswalk to 82542 x 1.5	$24.63 $36.95
801XY23 Antidepressants, serotonergic class; 3 to 5	ACLA, ASCP: Crosswalk to 82492 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$27.09 $98.52
801XY24 Antidepressants, serotonergic class, 6 or more	ACLA, ASCP: Crosswalk to 82492 + 20% AACC, ASCLS: Crosswalk to 82542 x 7	$29.55 $172.41
801XY25 Antidepressants, tricyclic and other cyclicals, 1 to 2	ACLA, ASCP: Crosswalk to 80152 AACC, ASCLS: Crosswalk to 82542 x 1.5	$24.42 $36.95
801XY26 Antidepressants, tricyclic and other cyclicals, 3 to 5	ACLA, ASCP: Crosswalk to 80152 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$26.86 $98.52
801XY27A Antidepressants, not otherwise specified	ACLA, ASCP: Crosswalk to 82492 AACC, ASCLS: Crosswalk to 82542	$24.63 $49.26
801CY34 Antiepileptics, not otherwise specified; 1 to 3	ACLA, ASCP: Crosswalk to 80156 AACC, ASCLS: Crosswalk to 82542 x 2	$19.87 $49.26
801XY35 Antiepileptics, not otherwise specified; 4 to 6	ACLA, ASCP: Crosswalk to 80156 + 10% AACC, ASCLS: Crosswalk to 82542 x 5	$21.85 $123.15
801XY36 Antiepileptics, not otherwise specified; 7 or more	ACLA, ASCP: Crosswalk to 80156 + 20% AACC, ASCLS: Crosswalk to 82542 x 8	$23.84 $197.04
801XY31 Antipsychotics, not otherwise specified; 1 to 3	ACLA, ASCP: Crosswalk to 80159 AACC, ASCLS: Crosswalk to 82542 x 2	$25.23 $49.26
801XY32 Antipsychotics, not otherwise specified, 4 to 6	ACLA, ASCP: Crosswalk to 80159 + 10% AACC, ASCLS: Crosswalk to 82542 x 5	$27.75 $123.15
801XY33 Antipsychotics, not otherwise specified; 7 or more	ACLA, ASCP: Crosswalk to 80159 + 20% AACC, ASCLS: Crosswalk to 82542 x 8	$30.27 $197.04
801XY4 Barbiturates	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82205	$15.62
801XY5 Benzodiazepines; 1-12	ACLA, ASCP, AACC, ASCLS: Crosswalk to 80154	$25.23
801XY6 Benzodiazepines; 13 or more	ACLA, ASCP: Crosswalk to 80154 + 10% AACC, ASCLS: Crosswalk to 80154 x 2	$27.75 $50.46
801XY12 Buprenorphine	ALCA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY37 Cannabinoids, natural	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 4	$24.63 $49.26
801XY38 Cannabinoids, synthetic; 1 to 3	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 2	$24.63 $49.26
801XY39 Cannabinoids, synthetic; 4 to 6	ACLA, ASCP: Crosswalk to 82492 + 10% AACC, ASCLS: Crosswalk to 82542 x 5	$27.09 $123.15
801XY40 Cannabinoids, synthetic; 7 or more	ACLA, ASCP: Crosswalk to 82492 + 20% AACC, ASCLS: Crosswalk to 82542 x 8	$29.55 $197.04
801XY43 Cocaine	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82520	$20.63
801XY13 Fentanyl	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY13B Gabapentin, non-blood	ACLA, ASCP: Crosswalk to 80171 AACC, ASCLS: Crosswalk to 82542	$18.09 $24.63
801XY9 Heroin metabolite	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY9A Katamine and norketamine	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82542	$24.63
801XY10 Methadone	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83840	$22.28
801XY17B Methylenedioxyamphetamines	ACLA, ASCP: Crosswalk to 82145 AACC, ASCLS: Crosswalk to 82542	$21.20 $24.63
801XY17C Methylphenidate	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82542	$24.63
801XY7 Opiates, 1 or more	ACLA, ASCP: Crosswalk to 83925 AACC, ASCLS: Crosswalk to 83925 + 82646 + 82649	$26.54 $89.78
801XY15 Opioids and opioid analogs; 1 to 2	ACLA, ASCP: Crosswalk to 83925 AACC, ASCLS: Crosswalk to 83925 x 1.5	$26.54 $39.81
801XY16 Opioids and opioid analogs; 3 to 4	ACLA, ASCP: Crosswalk to 83925 + 10% AACC, ASCLS: Crosswalk to 83925 x 3.5	$29.19 $92.89
801XY17 Opioids and opioid analogs; 5 or more	ACLA, ASCP: Crosswalk to 83925 + 20% AACC, ASCLS: Crosswalk to 83925 x 6	$31.84 $159.24
801XY8 Oxycodone	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY21 Phencyclidine	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83992	$20.05
801XY13A Pregabalin	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82542	$24.63
801XY7A Propoxphene	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY7B Sedative hypnotics (non-benzodiazepines)	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 2	$24.63 $49.26
801XY14 Skeletal muscle relaxants; 1 to 2	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 1.5	$24.63 $36.95
801XY14A Skeletal muscle relaxants; 3 or more	ACLA, ASCP: Crosswalk to 82542 + 10% AACC, ASCLS: Crosswalk to 82542 x 4	$27.09 $98.52
801XY41 Stimulants, synthetic	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 2	$24.63 $49.26
801XY42 Tapentadol	ACLA, ASCP, AACC, ASCLS: Crosswalk to 83925	$26.54
801XY48 Tramadol	ACLA, ASCP: Crosswalk to 83925 AACC, ASCLS: Crosswalk to 82542	$26.54 $24.63
801XY17A Stereoisomer analysis, single drug class	ACLA, ASCP, AACC, ASCLS: Crosswalk to 82542	$24.63
801XY45 Drugs or substances, definitive, qualitative, or quantitative, not otherwise specified; 1 to 3	ACLA, ASCP: Crosswalk to 82542 AACC, ASCLS: Crosswalk to 82542 x 2	$24.63 $49.26
801XY46 Drugs or substances, definitive, qualitative, or quantitative, not otherwise specified; 4 to 6	ACLA, ASCP: Crosswalk to 82542 + 10% AACC, ASCLS: Crosswalk to 82542 x 5	$27.09 $123.15
801XY47 Drugs or substances, definitive, qualitative, or quantitative, not otherwise specified; 7 or more	ACLA, ASCP: Crosswalk to 83925 + 20% AACC, ASCLS: Crosswalk to 82542 x 8	$29.55 $198.04
THERAPEUTIC DRUG ASSAYS
8XXX13 Digoxin; free	ACLA, ASCP, AACC, ASCLS: Crosswalk to 80162	$18.12
80XXX11 Valproic acid (dipropylacetic acid); free	ACLA, ASCP, AACC, ASCLS: Crosswalk to 80164	$18.49
MOLECULAR PATHOLOGY PROCEDURES TIER 1
8124X6 FLT3 (FMS-related tyrosine kinase 3), gene analysis tyrosine kinase domain (TKD) variants (eg, D835, I836)	ACLA, ASCP, AACC, ASCLS: Crosswalk to 81245	$165.92
8128X1 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) gene analysis; promoter methylation analysis	ACLA, ASCP, AACC, ASCLS: Crosswalk to 81294	$190.68
8131X3 PCA3/KLK3 Prostate cancer antigen 3/kallikrein-related peptidase 3	ACLA, ASCP: Crosswalk to 81293 AACC, ASCLS: Crosswalk to 81315	$256.06 $282.83
Source: G2 Intelligence from association comments

  Coding recommendations for genomic sequencing procedures, multianalyte assays with algorithmic analyses, chemistry, microbiology, reproductive medicine procedures, and G codes will be included in the next issue of National Intelligence Report.