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The CAP advocated for fair clinical laboratory payments by recommending the use of crosswalk payment methodology for new CPT codes during the Centers for Medicare and Medicaid Services (CMS) Annual Clinical Laboratory Public Meeting. During the June 25 meeting, the CAP recommended payment amounts for more than 45 new CPT codes for CMS consideration and inclusion in the 2019 Medicare clinical laboratory fee schedule (CLFS).

Michael Idowu, MD, MPH, FCAP, who is a Professor of Pathology and the Director of the Molecular Genetic Pathology Fellowship at the Virginia Commonwealth University Medical Center, presented recommendations on behalf of the CAP. Dr. Idowu advocated for use of a crosswalk payment methodology in order to establish payment amounts for the new clinical laboratory CPT codes to be added in the 2019 CLFS. The CAP has consistently advocated for use of a crosswalk methodology to establish national pricing for new genomic sequencing procedures (GSP) and Molecular Pathology CPT codes. In his testimony on behalf of the CAP, Dr. Idowu emphasized that many services within the molecular pathology and genomic sequencing procedures subsections of CPT require similar resources and use comparable technologies which are directly applicable for crosswalk valuation.

During the meeting, the CAP presented crosswalk payment recommendations for several of the new Tier 1 Molecular Pathology and GSP codes including:

  • Code 81X11 MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom’s macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant
  • Code 81X78 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
  • Code 81X43 Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes

The CAP will continue to advocate for the establishment of national payment rates for the new Category I CPT codes with the CMS before the fall 2018 release of the final 2019 CLFS.

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The CMS just released the 2017 Merit-based Incentive Payment System (MIPS) data where participating clinicians can view their performance feedback and final MIPS scores.

If you submitted MIPS data for the 2017 reporting period, you can access your performance feedback and final score by:

  • Going to the Quality Payment Program website
  • Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. If you don’t have an EIDM account, refer to this guide and start the process now

The final score should take into account any special status, such as non-patient-facing or hospital-based physicians. In the coming weeks, the CMS will provide further assistance in interpreting your feedback.

Your 2017 MIPS performance will determine payment adjustments to your Medicare Part B payments in 2019 of +/- 4%.

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The CAP, along with AdvaMed and the Amputee Coalition, authored an article calling for more transparency and accountability in Medicare’s local coverage process in order to protect patients. The opinion piece, which appeared on June 27, was published by STAT, health care news media company.

In the op-ed article, the three groups detailed the need for LCD reform by citing how coverage determinations impact patients and technology on the regional level. “In our work with physicians, patients, and medical technology companies, we have seen coverage decisions ignore medical evidence and Medicare program requirements,” wrote CAP President R. Bruce Williams, MD, FCAP, AdvaMed President and CEO Scott Whitaker, and Amputee Coalition President and CEO Jack Richmond. “Ultimately, these decisions place people with disabilities and older Americans at risk.”

Read the full op-ed in STAT.

July 11, 2018
1 pm ET/ 12 pm CT

Register today.

In the coming days, the CMS will issue its proposed updates to the 2019 Medicare Physician Fee Schedule and the Quality Payment Program regulations, including the Merit-based Incentive Payment System (MIPS).

Regulation changes will impact payment for services and pathologists’ participation in MIPS. Throughout this 60-minute panel discussion, CAP experts will review the proposed changes to the fee schedule and MIPS. The webinar will begin at 1 PM ET on July 11. The CMS will finalize the 2019 Physician Fee Schedule and Quality Payment Program regulations during the fall of 2018.

Presenters are:

Donald Karcher, MD, FCAP

Donald S. Karcher, MD, FCAP
Chair of the Council on Government and Professional Affairs

Emily E. Volk, MD, FCAP

Emily E. Volk, MD, FCAP
Vice-Chair of the Council on Government and Professional Affairs
Chair of the CAP Clinical Data Registry Ad-Hoc Committee

W. Stephen Black-Schaffer MD, FCAP

W. Stephen Black-Schaffer MD, FCAP
Chair of the CAP Economic Affairs Committee

Learn and understand the practice and financial implications that these Medicare program changes will have on pathologists in 2019. Register Today.

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