CGS Takes Palmetto's Lead on New Prices

In a move that should not surprise molecular diagnostic labs, Cigna Government Services, the Medicare Contractor for Ohio and Kentucky has updated their fee schedule to match the new prices released by Palmetto 2 weeks ago. After receiving gapfill analysis information from both CCLA members and other independent labs that (coordinated through XIFIN) at the end of March, Palmetto had revised their fees for BRAF, KRAS, EGFR, CYP2C9, CYP2C19, CYP2D6, JAK2* and FV*. While many of the Medicare Contractors used Palmetto’s initial fee schedule as a baseline for their own fees, CGS is now the first to adjust their molecular pathology code fee schedule in accordance with the upwardly revised fees that Palmetto had posted on April 3rd. 

NGS had posted updated fees last week but they matched the old pricing released by Palmetto prior to updating their fees at the beginning of April. This would appear to be a timing issue and we still expect to see Medicare Contractors come into line with Palmetto’s new pricing. Laboratories cannot afford to let up on continuing to submit data and appealing on both the 8 tests listed above as well as other tier 1 and tier 2 tests that have been priced inappropriately. It is also important to continue to communicate with legislators and other influencers. While it is heartening to see these prices trending upwards, even these updated prices are below where they need to be. While we continue to put pressure on pricing for the 8 tests above, we are compiling gapfill analysis data for tests such as:
FII Gene
FV Gene*
* Not included in the CCLA analysis
We expect to continue to bring others tests into the scope of this gapfill/crosswalk exercise over the next couple of weeks and we welcome labs to provide any information they have on testing that currently falls under the tier 1 and tier 2 fee schedules. We will continue to keep you updated as new information becomes available.
XIFIN is tracking published MAC allowed amounts, see the list here


Published by XIFIN
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