The Tempest Continues, Fee Schedules in Collision

July 13, 2012

Medicare and Genomic Tests Prepare for 2013

Understanding the genomic basis of the disease is the biological revolution of our times. While pharmaceutical companies are learning how to apply it for a new generation of medicines, Medicare is trying to figure out how to use five-digit codes to identify genomic tests and how to assign prices to them. The AMA CPT committee published over 100 new genomic codes in October 2011 for use beginning in January 2012, but Medicare declined to allow use of the codes in 2012. This initial code set is just the beginning of a set of changes that will allow genomic tests to be recorded in standard formats in medical records and in transactions between providers and insurers. How Medicare sets policy for these 100-odd first genomic codes will be precedential and is being watched closely. This white paper discusses CMS’s current policymaking and describes the likely outcomes for the 2012 policymaking process.

Download the Foley Hoag The Tempest Continues, Fee Schedules in Collision: Medicare and Genomic Tests Prepare for 2013 eBook(.pdf)