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Final OPPS Rule Increases Drug Payments

HealthLeaders Media Staff, for HealthLeaders Media, November 5, 2012

Molecular pathology payments

Another significant change also comes from the MPFS regarding payment for molecular pathology services and new CPT codes. Over the past two years the AMA has made significant additions to the molecular pathology CPT codes which first appeared in the 2012 CPT® Manualand are expanded in the 2013 manual.

CMS will pay for the new Molecular Pathology CPT codes under the Clinical Laboratory Fee Schedule (CLFS) instead of the MPFS. This issue has been under great debate for the last two years, which may be one reason why CMS did not implement the new codes in 2012 and instead allowed hospitals to continue reporting the "stacking codes."

But that changes as of January 1, 2013 when the stacking codes will be deleted and replaced with 100+ new codes that will go live and be paid under the CLFS, Shah says.

Facilities will need to make sure their charge masters are up-to-date with the new codes and with appropriate dollar charges. Setting appropriate charges is going to be a challenge since crosswalks don't exist from the non-specific stacking codes to the new CPT codes so if hospitals haven't already started working through this, they will need to right away, Shah says.

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