Medicare Program; Public Meeting in 2012 for New Clinical Laboratory Tests Payment Determinations

CMS will hear public comments at a meeting to be held July 16 and 17, 2012 on recommendations for establishing payment for new CPT codes being considered for Medicare payment under the clinical laboratory fee schedule (CLFS) for 2013. Some of these tests are molecular pathology tests. Stakeholders in the molecular pathology community continue to debate whether Medicare should pay for molecular pathology tests under the CLFS or the physician fee schedule (PFS). Medicare pays for clinical diagnostic laboratory tests through the CLFS and for services that ordinarily require physician work through the PFS. CMS will make final decisions with respect to molecular pathology codes in the CY 2013 PFS final rule with comment period, and will post on their Web site the final payment determinations for any codes paid under the CLFS in November. In addition, CMS intends to post their proposed determinations with respect to the appropriate basis for establishing a payment amount under the CLFS for each of these new test codes by September 28, 2012. If they later decide, based on comments received in response to the proposals in the CY 2013 PFS proposed rule, that any of these codes are not clinical diagnostic laboratory test codes, they will post their final payment determinations only for the new test codes that they determine are clinical diagnostic laboratory test codes that will be paid under the CLFS. They intend to post these final payment determinations in November (at the same time as the CY 2013 PFS final rule with comment period is published).

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