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The CAP urged the Medicare program to discard arbitrary discounts to pathology services and called on the Centers for Medicare & Medicaid Services (CMS) to accept reimbursement values derived from survey data, the CAP stated in a letter to the agency.

Based on flawed assumptions for 2015, the CMS had discounted the add-on services for immunofluorescence, immunohistochemistry, and in situ hybridization services from the original recommended relative value units (RVUs) for physician work by 40%. In the Medicare Physician Fee Schedule for 2016, the CMS increased the physician work values for the add-on codes, but still retained a 24% discount for the add-on services when compared to the base code.

While the change represented an overall increase to values, the CAP stated in a December 29 letter to the CMS that the Medicare agency should not apply discounts to the recommended values for the add-on services.

Read the CAP's comments to the CMS. In addition, read the CAP’s full coverage of the final 2016 Physician Fee Schedule. In the 2016 final rule, the CMS finalized several increases sought by the CAP for pathology services.

Immunofluorescent Studies

Specifically, the CAP disagrees with arbitrary and inappropriate physician time ratio comparison calculations. The comparisons are not relative resource based and are contrary to Medicare statute, the CAP said.

In the 2016 Medicare Physician Fee Schedule, the CMS did not accept the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee’s (RUC’s) physician work recommendation for CPT code 88350. The CMS compared immunofluorescent services (codes 88346 and 88350) to two obsolete intravascular ultrasound CPT codes (codes 37250 and 37251) for their ratio of physician time to work relative values. "The comparison of two add-on services of high complexity and intensity, performed during a diagnostic evaluation and/or therapeutic intervention, to one pathology base code and one add-on service is an unprecedented valuation methodology contrary to statute," the CAP said.

"Both 37250 and 37251 have been recently deleted from CPT and there should be no comparison of these codes to the immunofluorescent studies codes," the CAP said. "The CAP does not agree with the arbitrary calculation that has led to the incorrect valuations of these codes and rank order anomalies across a wide range of services."

In Situ Hybridization (FISH), Immunohistochemistry Services

For 2016, the CMS applied similar discounts to add-on codes for in situ hybridization and immunohistochemistry services. The CAP states there is no rationale for a 24% discount to the services, which included the immunohistochemistry add-on service (88341), add-on service for FISH (88364), and manual HER2 (88369).

The CAP again urged the agency to discard its inappropriate physician time ratio comparisons and accept the RUC process of utilizing the relative resources reflected in the RUC values derived from survey data.

Standard Tasks and Minutes for Clinical Labor Tasks

As stated in the CAP's comments in response to the 2016 proposed fee schedule, the CAP does not support the standardization of clinical labor activities across all pathology services because each pathology service encompasses distinct and unique clinical labor tasks. Furthermore, the CAP stated it does not believe that the standards finalized by the CMS are unaffected by batch and block size, as the agency has stated.

"The CAP urges the CMS not to standardize any clinical labor activities at this time and to return all of the clinical labor time standardized in the CY 2016 rulemaking process to previous levels for the first quarterly update of the physician fee schedule," the CAP stated.

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CAP members can access the archived recording of the CAP's webinar "The 2016 Medicare Physician Fee Schedule's Impact on Pathology Services" at any time. During the webinar, CAP experts explained reimbursement and policy changes to pathology services in the 2016 fee schedule recently published in 2015.

The slides for the presentation are also available for download.

Recording of CAP's PAMA Webinar

Watch the archived recording of the CAP’s December 17 webinar on how the PAMA regulations will affect laboratory operations and future Medicare clinical laboratory fee schedule payments (CLFS).

The proposed regulations would require collecting from applicable laboratories data on payments received from private payers for clinical laboratory services and basing CLFS payments on the weighted median of this information in 2017. Applicable laboratories as defined under the proposed rule could face significant monetary penalties for non-compliance.

View the recording and the slides to this presentation.

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Registration is now open for you to join your colleagues at the 2016 CAP Policy Meeting May 2-4 in Washington, DC. The annual event is the pathology specialty's opportunity to focus on the federal issues most important to pathologists now and in the future.

The 2016 Policy Meeting will feature guest speakers from Washington and pathology leaders from across the country. On May 4, pathologists will visit with their elected officials during the CAP's annual Hill Day. Meeting with your representative or senator is your chance to discuss the issues affecting pathology and the patients you care for every day.

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