CAP asks CMS to Delay or Revoke Palmetto’s MolDx

Representatives from the College of American Pathologists met with CMS to express concerns regarding the Molecular Diagnostics (MolDx) reporting program announced by Palmetto GBA in November 2011, and asked CMS to delay or revoke the program. Palmetto’s adoption of the Z-codes amounts to the creation of a local coding system, which violates the Health Information Portability Act (HIPAA), CAP leaders told CMS during the meeting. “By statute, local codes are not permitted,” said Jonathan Myles, MD, a pathologist at the Cleveland Clinic, and Chair of CAP’s Economic Affairs Committee, who together with Stephen Black-Schaffer, MD, led the CAP delegation at the meeting. “Palmetto’s creation and use of its Z-codes would circumvent the process of stakeholder input into changes prior to implementation,” he added. CAP is also concerned about the lack of transparency in how the panel members are chosen, and that Palmetto’s process may not be compliant with the Federal Advisory Committee Act, which covers advisory committees and conflicts of interest. In addition, the CAP believes that Palmetto’s proposed modified gap-fill payment policy is inconsistent with existing payment rules and that the existing payment mechanisms should be used instead to develop payment amounts for laboratory services.