Pathologist Group Asks Medicare to Reconsider Payment for BRCA Genetic Testing CPT Codes

The Association for Molecular Pathology has asked Medicare to increase the payment amounts for two CPT codes attached to testing procedures for BRCA1 and BRCA2 genes by considering the work and resources that labs invest in analyzing these large and variable genes. 

The Centers for Medicare & Medicaid Services in December 2018 released the clinical lab fee schedule final payment amounts to take effect Jan.1, 2019. Among the priced CPT codes, CMS said Medicare would pay $468 for CPT code 81163 describing full sequencing of BRCA1/2 and $283 for CPT code 81165 describing sequencing of just BRCA1.

“We do not feel this is a reasonable crosswalk,” AMP wrote and suggested CMS crosswalk to CPT code 81408, and price it 50 percent less at $1,000 to more accurately reflect the resources required.

Source: https://www.genomeweb.com/reimbursement/pathologist-group-asks-medicare-reconsider-payment-brca-genetic-testing-cpt-codes