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The American College of Medical Genetics and Genomics (ACMG) is requesting help from laboratories to collect actual, fully-loaded costs associated with running commonly performed molecular pathology tests. This information will be compiled into a rate-setting resource submission to the Centers for Medicare and Medicaid Services (CMS) to support their process in establishing payment rates for these tests. Please help in this critical effort to ensure sustainable reimbursement rates for diagnostic services. Many ASHI laboratories will at least be able to provide input in relation to codes 81265 and 81267.
Background
Payers such as Medicare are currently developing payment rates for the Tier 1 and Tier 2 molecular pathology tests and many have not established equitable rates. Using aggregate cost data from real laboratories performing these services, ACMG can demonstrate that the many payment rates do not even cover the cost of performing the test and thus advocate for better payment. ACMG is interested in the following codes:
- 81220 - CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines)
- 81228 - Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (eg, Bacterial Artificial Chromosome (BAC) or oligo-based comparative genomic hybridization (CGH) microarray analysis
- 81229 - Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants for chromosomal abnormalities
- 81243 - FMR1 (Fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles
- 81244 - FMR1 (Fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and methylation status)
- 81265 - Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline [eg, buccal swab or other germline tissue sample] and donor testing, twin zygosity testing, or maternal cell contamination of fetal cells)
- 81267 - Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; without cell selection
- 81280 - Long QT syndrome gene analyses (eg, KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CACNA1C, CAV3, SCN4B, AKAP, SNTA1, and ANK2); full sequence analysis
- 81331 - SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome and/or Angelman syndrome), methylation analysis
Method
The ACMG is asking for your help in submitting your laboratory's costs for performing one of the tests listed above. Please fill in the fully-loaded cost data survey here for each test you run at your lab by June 28, 2013. The data specific to your laboratory will NOT be identified. |
