Gapfill Pricing on NGS codes released

CMS chose to gap-fill the payment amounts for new Tier 1 gene assays and Next Generation Sequencing (NGS) procedures listed on the 2015 Medicare Clinical Laboratory Fee Schedule. The gap-fill protocol requires CMS to publish preliminary amounts paid by their contractors by the end of April. CMS’ latest publication is disappointing because they chose to only release payment amounts for 10 of the 30 codes. For those 10 codes with payment information, in most cases only some of the contractors (MACs) reported an amount. The public may submit comments to CMS concerning these preliminary payment amounts until July 20, 2015. After the 60-day comment period has ended, CMS will share the comments with the MACs and post final prices on its website sometime during September.  The final step in the gap filling process will be to establish a single National Limitation Amount (NLA) based on the median of final fees published by CMS. These fees will be effective January 1, 2016, but may be subject to reconsideration. The NLAs for individual tests will be uniform throughout the country with no variation from state to state.