Novitas Solutions, Inc. (Novitas), the Medicare Administrative Contractor (MAC) for Jurisdictions H and L (JH and JL) is in receipt of the new laboratory test codes identified by the Centers for Medicare & Medicaid Services (CMS) to be gap-fill priced for 2021. The Protecting Access to Medicare Act (PAMA) regulations instruct the MACs to establish local payment amounts for the new laboratory test codes using the following sources of information, if available:
1. Charges for the test and routine discounts to charges
2. Resources required to perform the test
3. Payment amounts determined by other payors
4. Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant
Novitas seeks your input on establishing pricing under the Medicare program for new laboratory test codes 86328, 86769, 87635, 0101U, 0102U, 0103U, 0129U, 0139U, 0140U, 0141U, 0142U, 0143U, 0144U, 0151U, 0152U, 0153U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0163U, 0164U, 0165U, 0171U, 0173U, 0174U, 0175U, 0178U, 0179U, 0180U, 0206U, 0207U, 0208U, 0209U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0219U, 0220U, 0221U, 0222U, 0015M, 0016M, U0001, U0002, U0003, and U0004. To that end, Novitas kindly requests that you complete our molecular diagnostic pathology survey by March 8, 2021.
Please note that your answers will be kept to the greatest degree of confidentiality and will not be disclosed, except as may be necessary to share with others under confidentiality agreements with CMS for the sole purpose of establishing Medicare clinical laboratory fee schedule gap filling pricing.
Your responses will be reviewed and evaluated by Novitas and if proper, set forth in its recommendations to CMS of the appropriate fees for these tests. If no response is received, the fee will be determined by evaluating the charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant.
Note: The presence of an established local payment amount does not imply coverage.