Understanding the processes for coding, pricing and coverage determination is at the heart of getting reimbursed for the clinical molecular procedures we perform. This panel will review those processes and hear insights from a Medical Director for the Palmetto Medicare Administrative Contractor to help members understand the intent and breadth of the molecular procedure codes, understand how coverage policies and procedures affect determination of payment or nonpayment including the National Coverage Determination for NGS testing, and discuss the pricing process and the impact of PAMA on laboratory pricing. The three presentations will be followed by a panel discussion and Q&A session.
Anthony Sireci, MD, Loxo Oncology, Stamford, CT, USA
Aaron Bossler, MD, PhD, University of Iowa, Iowa City, IA, USA
Demystifying Molecular testing coverage and policies: MolDX and Medicare
Gabriel Bien-Willner. MD, PhD, Palmetto GBA, TX, USA
Objectives:
- Understand current test coding and define tier 1 molecular pathology CPT codes.
- Understand how coverage polices determine payment or nonpayment.• Understand and describe the impact of PAMA on laboratory pricing.
Duration: 1.25 hr
Recording Date: November 7, 2019
CME/CMLE credit: 1.25 hr
Last day to purchase course and CE claim credit: December 24, 2022
