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Focus On: Clinical Laboratory Fee Schedule: Industry Groups Give Recommendations on 2015 Lab Test Codes

by | Feb 25, 2015 | Essential, Focus On-nir, National Lab Reporter

Leading lab and pathology groups recently made recommendations to the Centers for Medicare and Medicaid Services on new and revised codes that will be added to the Clinical Laboratory Fee Schedule effective Jan. 1, 2015. This is the second part of coding recommendations; the first part of the recommendations was included in the July 24, 2014, issue of National Intelligence Report. MEDICARE LAB FEE SCHEDULE FOR 2015: NEW CPT CODES AND PAYMENT RECOMMENDATIONS CODE DESCRIPTOR CODE CROSSWALK OR GAP-FILL PROPOSED NLA GENOMIC SEQUENCING PROCEDURES 81410X Aortic dysfunction or dilation genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 2 — $1,292.48 81411X Aortic dysfunction or dilation (duplication/deletion analysis), panel must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1 ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 2 — $904.74 81415X Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 9.9 — $6,397.78 81416X Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswak to 81292 […]

Leading lab and pathology groups recently made recommendations to the Centers for Medicare and Medicaid Services on new and revised codes that will be added to the Clinical Laboratory Fee Schedule effective Jan. 1, 2015. This is the second part of coding recommendations; the first part of the recommendations was included in the July 24, 2014, issue of National Intelligence Report.
MEDICARE LAB FEE SCHEDULE FOR 2015: NEW CPT CODES AND PAYMENT RECOMMENDATIONS
CODE DESCRIPTORCODE CROSSWALK OR GAP-FILL PROPOSED NLA
GENOMIC SEQUENCING PROCEDURES
81410X Aortic dysfunction or dilation genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLKACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 2— $1,292.48
81411X Aortic dysfunction or dilation (duplication/deletion analysis), panel must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 2— $904.74
81415X Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysisACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 9.9— $6,397.78
81416X Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exomeACLA, ASCP: Gap-fill AACC, ASCLS: Crosswak to 81292 x 9.9— $6,397.78
81420X Fetal chromosomal aneuploidy (eg, trisomy 21,monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 4— $2,584.96
801XY3 Alcohol biomarkers; 3 or moreACLA, ASCP, AACC, ASCLS: Gap-fill
81426X Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genomeACLA, ASCP, AACC, ASCLS: Gap-fill
81427X Genome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequenceACLA, ASCP, AACC, ASCLS: Gap-fill
81430X Hearing loss, genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 4— $2,584.96
81431X Hearing loss, duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 genesACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 0.7— $452.37
81435X Hereditary colon cancer syndromes, genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2ACLA, ASCP, AACC, ASCLS: Gap-fill
81436X Hereditary colon cancer syndromes, duplication/deletion gene analysis panel, must include analysis of at least 8 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYHACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 2— $1, 292.48
81440X Nuclear encoded mitochondrial genes (eg, neurologic or myopathic phenotypes), genomic sequence panel, must include analysis of at least 100 genes.ACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 3.9— $2,520.34
81445X Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genesACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 3.9— $2,520.34
81455X Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA and RNA analysis when performed, 51 or greater genesACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 3.9— $2,520.34
81460X Whole mitochondrial genome, must include sequence analysis of entire mitochondrial genome with heteroplasmy detectionACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 3.6— $2,326.46
81465X Whole mitochondrial genome large deletion analysis panelACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 3.6— $2,326.46
81470X X-linked intellectual disabilityACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 4— $2,584.96
81471X X-linked intellectual disabilityACLA, ASCP: Gap-fill AACC, ASCLS: Crosswalk to 81292 x 4— $2,584.96
MULTIANALYTE ASSAYS WITH ALGORITHMIC ANALYSES
815XX Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score Oncotype DX® Breast Cancer Assay (Genomic Health, Inc.)ACLA, ASCP, AACC, ASCLS: Gap-fill
CHEMISTRY
83005X Growth stimulation expressed gene 2 (ST2, interleukin I receptor like-1)ACLA, ASCP, AACC, ASCLS: Crosswalk to 82777$30.01
MICROBIOLOGY
8751X1 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 3-5 targets2ACLA, ASCP, AACC, ASCLS: Crosswalk to 87631$175.02
8751X2 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 6-11 targetsACLA, ASCP, AACC, ASCLS: Crosswalk to 87632$291.18
8751X3 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen, 12-25 targetsACLA, ASCP, AACC, ASCLS: Crosswalk to 87633$568.60
876XX3 Infectious agent detection by nucleic acid (DNA or RNA);Human Papillomavirus (HPV), low-risk types (eg 6,11,42,43,44)ACLA, ASCP, AACC, ASCLS: Crosswalk to 87621$47.87
876XX4 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg 16,18,31,33,35,39,45,51,52,56,58,59,68)ACLA, ASCP, AACC, ASCLS: Crosswalk to 87621$47.87
87806X Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodiesACLA, ASCP: Crosswalk to 87389 AACC, ASCLS: Crosswalk to 87390$32.86 $42.76
REPRODUCTIVE MEDICINE PROCEDURES
893XX7 Cryopreservation; mature oocytesACLA, ASCP: Crosswalk to 89258No NLA listed in 2014 CLFS
G CODES
GXXXX Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)ACLA, ASCP: No comment, pending discussion AACC, ASCLS: Crosswalk to 82274 + 81275 + 81315— $501.78
Source: G2 Intelligence from association comments.

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