Starting this year, the US Centers for Medicare and Medicaid Services (CMS) has instituted a new system for Common Procedural Terminology codes, which are used to bill Medicare for molecular diagnostics tests. Test 1 tests include most of the tests already in use. Tier 2 consists of low-volume, esoteric test divided among nine levels. Pricing schemes for the old codes will not be updated until January 2014. Until then, local administrative contractors are required to create their own pricing schemes. But because the previous codes for specific tests were often grouped together, pricing each test separately has created confusion. It is expected that many providers will follow the lead of Palmetto GBA, the only administration contractor with its own molecular diagnostics program.

Source: Clinical Laboratory News