Study Explores Recent Migration of CPT Codes for Reimbursement of Genomic Tests

The Journal of Molecular Diagnostics, in its March 2018 (Vol 20, No. 2) issue, has published an important article by several of our department’s faculty and staff. The article, entitled "The History and Impact of Molecular Coding Changes on Coverage and Reimbursement of Molecular Diagnostic Tests", explores the history of coding and payment for genomic tests in the light of recent changes in Current Procedural Terminology (CPT) coding. Specifically, it discusses the migration of CPT stack codes to tier 1 CPT codes and combined tier 1 and tier 2 CPT codes for reimbursement under the Genome Sequencing Procedures code. The two examples in this study include T-cell gene rearrangement for leukemia and lymphoma genotyping and a next-generation sequencing (NGS)–based laboratory-developed test for the interrogation of mutations in the genomes of solid tumors. The authors present data demonstrating CPT code changes coupled to both sharp increases in reimbursement rejection rates and decreased absolute payments.

To read the full text of this article, please click HERE.