In This Issue...

CMS Releases Preliminary Payment Rates for 2014 CPT Codes and Revised Molecular Rates

The Centers for Medicare and Medicaid Services recently released the long awaited documents listing the preliminary payment rates for the new 2014 CPT Codes and the revised gapfill prices for the molecular pathology codes.   

For the new CPT codes, CMS agreed with nearly all AACC’s proposed crosswalks for the Therapeutic Drug Assays.  However, the agency refused to reconsider payments for multi-analyte algorithm assays, asserting that an “algorithm is not a clinical diagnostic test.”

In regards to the molecular document, CMS established fees for only 65 of the 114 CPT codes.  The agency stated that “only those codes that are currently being paid” by Medicare Administrative Contractors (MACs) were assigned a national limitation amount.  Laboratories will be required to negotiate separately with MACs to get reimbursed for those tests not on the list.  CMS will be accepting comments on the revised gapfilled codes through October 30th.

HCR Insurance Exchanges Open for Business

On October 1st, the federal government and 16 states opened health insurance exchanges to enroll individuals without insurance in one of the government-accepted health plans.   All Americans without insurance are required to choose a plan prior to January 1, 2014 or be subject to fines up to 1 percent of their household income.  The government will provide subsidies to individuals making up to 400 percent of the poverty rate.  Each participating plan must offer certain ‘essential’ health services, such as laboratory testing.  Although a number of exchanges reported technical glitches on the first day, many reported high consumer traffic on their websites.  The Obama Administration predicts that up to 29 million Americans will purchase insurance through the exchanges by 2019.

White House Opposes Device Tax Repeal as Part of CR Agreement

Senators John McCain (R-AZ) and Lindsey Graham (R-SC) recently suggested amending the continuing resolution (CR) necessary to fund government operations to include a provision repealing the Medical Device Tax that was included in the 2010 Affordable Care Act.  Although repealing the provision has significant support within both the House and Senate, some lawmakers have expressed concerns about replacing the $30 billion in lost revenues.   The White House and Senate Democratic leadership oppose adding the amendment to the CR arguing that Congress should enact a ‘clean’ bill without amendments.   Senators Amy Klobuchar (D-MN) and Orrin Hatch (R-UT), the two leading proponents of repeal, have vowed to pursue other legislative mechanisms to repeal the provision.