After months of consideration, the Center for Medicare & Medicaid Services (CMS) announced that the new 2013 Molecular Pathology CPT Codes (MPCC) will be paid under the Clinical Laboratory Fee Schedule (CLFS) using the gap-fill method. CMS concluded that the new 2013 MPCC describes clinical diagnostic laboratory tests that should be paid under the CLFS because these services do not ordinarily require interpretation by a physician to produce a meaningful result. However, in some cases, a physician interpretation of molecular pathology tests may be medically necessary to provide a clinically meaningful, recipient-specific result. In order to make a Physician Fee Schedule (PFS) payment for that physician’s interpretation, on an interim basis for 2013, CMS has created HCPCS G0452 (molecular pathology procedure; physician interpretation and report). This professional component, only HCPCS G-code, will be considered a “clinical laboratory interpretation service.” The current CPT code for interpretation and report, 83912-26, will be deleted at the end of calendar year 2012. HCPCS code G0452 will be paid under the PFS and directly cross walked to CPT code 83912-26.
Under the gap-fill method, Medicare contractors will determine reimbursement based on local pricing patterns, i.e., charges for the tests, discounts on the charges, required resources, payment amounts determined by other payors; and charges, resources and payment amounts for tests that may be comparable. CMS is then expected to use various regional reimbursement determinations to arrive at a final national reimbursement rate that would be implemented in 2014. We will continue to monitor the industry’s usage and price determinations of these new codes. As we learn more about the effective usage of these codes and how they are applicable to our billing process, we will inform you of any changes.
Be that as it may, effective January 1, 2013, the University of Chicago Genetic Services Laboratory, will start using the new 2013 Molecular Pathology CPT Codes. The updated tests catalog (aka “quick guide”) will be made available on our website (www.dnatesting.uchicago.edu).