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The CAP recommended national pricing for new genomic sequencing procedures and other laboratory test CPT codes under consideration in the 2017 Medicare clinical laboratory fee schedule (CLFS).

The CMS held its Annual Laboratory Public Meeting and Medicare Advisory Panel on Clinical Diagnostic Tests on July 18. The CAP made crosswalk payment recommendations to support the implementation of the new genomic sequencing procedure CPT codes by the Medicare program in 2017. Many services within the molecular pathology subsection and genomic sequencing procedure subsection of CPT require similar resources and use comparable technologies which are directly applicable for crosswalk valuation, said Ronald W. McLawhon, MD, PhD, FCAP, who presented on behalf of the CAP. Dr. McLawhon is the CAP's CPT Advisor and heads the CPT-RUC subcommittee of the Economic Affairs Committee.

The CAP remains concerned with regard to transparency issues associated with the gapfill process for the molecular pathology and genomic sequencing codes. The gapfill process requires Medicare contractors to establish individual rates that have led to non-payment or inadequate payment for some services when individual contractors fail to establish pricing that includes the resources necessary for laboratories to perform the test.

Read the CAP's 2017 CLFS recommendations.

Following presentations from the public, the Medicare Advisory Panel on Clinical Diagnostic Tests also considered new and revised tests. The Protecting Access to Medicare Act of 2014 (PAMA) created the expert advisory panel to provide recommendations on coverage and payment rates for clinical diagnostic laboratory tests (CDLTs). The panel is composed of 15 individuals, including two members nominated by the CAP, and a chairperson. Recommendations from the Medicare Advisory Panel will be published on the CMS website following the meeting and will also inform the CMS' preliminary decisions for the CLFS 2017.

The CAP welcomes further dialogue with CMS officials regarding the resources necessary to perform, and the clinical uses of, the molecular pathology and genomic sequencing procedures and other services provided to Medicare and/or Medicaid beneficiaries. In September 2016, the CMS will publish preliminary payment determinations for the 2017 CLFS. The basis of payment and the amount of payment will become final at the same time that the CMS issues the annual CMS CLFS instruction for 2017 in November.

Read more about PAMA.

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Registration is now open for key CAP policy and advocacy courses and roundtable discussions important to the pathology specialty during CAP16 in Las Vegas September 25-28.

Ensure you can attend "MACRA, Pay for Performance and the Physician Fee Schedule—You Can Run But You Can't Hide" (S1620) by registering and selecting this popular course today. During this featured presentation, attendees will learn the purpose of new pay-for-performance programs and delivery system reform culminating in the enactment and implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). Experts will explain which pathologists are subject to, and ways to successfully participate in, the merit-based incentive payment system and alternative payment model pathways. The potential ramifications for not participating will also be discussed.

The session starts at 8 AM on Monday, September 26. Register for S1620 MACRA, Pay for Performance and the Physician Fee Schedule—You Can Run But You Can't Hide today.

Additional CAP advocacy courses and roundtable discussions are also available at CAP16:

  • M1596 How is My Payment Determined for Pathology Services?
    Sunday, September 25, 1-2 PM
  • R1690 My Surgical Pathology and Cytopathology Coding Dilemmas: Getting It Right
    Monday, September 26, Noon to 1 PM
  • STA001 "How Data Drives CAP Advocacy: What Pathologists are Saying about the Economics of Pathology Practice"
    Monday, September 26, 5:30-6:30 PM
  • R1691 Current Payment Policy Challenges in Pathology Practice
    Tuesday, September 27, Noon to 1 PM

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View and download the CAP's recent analysis of federal regulations proposing Medicare payment changes concerning pathology services.

On July 14, CAP leaders discussed and explained changes to pathology reimbursement in the proposed 2017 Medicare Physician Fee Schedule during a webinar presentation. The proposed 2017 fee schedule includes maintaining the value for several pathology codes targeted as misvalued and gains for add-on codes used for immunohistochemistry and immunofluorescence services, which the CAP had strongly advocated for in 2014, 2015, and 2016.

CAP members can access the:

CAP members can also view the archive recording and download the presentation slides for the CAP's July 7 webinar on the proposed regulation implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The MACRA regulation would set two payment pathways for physicians beginning in 2019: the MIPS and APMs. MIPS is expected to have an estimated $1.5 billion impact on payments to pathologists. Physicians participating in eligible APMs would not be subject to MIPS and would receive 5% Medicare payment bonuses.

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Register today for a July 27 webinar presentation on the foundations and principles of CAP advocacy. During this complimentary presentation for residents, you will receive key information about the CAP’s advocacy structure and policy agenda for pathologists and their patients.

The webinar starts at 1 PM EDT with presenters Emily E. Volk, MD, MBA, FCAP, chair of the CAP Council on Government and Professional Affairs, and Joseph Sanfrancesco, MD, member of the Residents Forum Executive Committee, leading the discussion. Our presenters will discuss the fundamentals of:

  • US health policy
  • Medicare payment
  • New health care payment models

Finally, attendees will learn how to get involved in CAP initiatives and how to advocate for their patients. Toward the end of the presentation, our panel will answer your questions.

Register today.

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