Saturday, September 23, 2017

Table of PAMA Prices for GSP Codes

This represents my "informal" table of PAMA prices for GSP codes.  

2017 CLFS "NA" and 2018 PAMA price means that these codes are getting CLFS prices for the first time through the normal PAMA process.  They are old enough to be in the 2016 PAMA payment prices but were never given CMS prices.

Blue typically is codes priced in 2016 by crosswalk for first use in 2017.  They don't get PAMA prices - since they weren't in use in 2016 - so CMS generally assigns the 2018 price to be a continued crosswalk.  

Purple typically is codes that were around in 2016 but NEITHER had been priced by CMS, NOR had PAMA data.  These are new in-house crosswalks being proposed by CMS.  CMS also considered the alternative of leaving them off the fee schedule since they had neither CMS prices nor PAMA data.

81416 Exome Compare $12K omitted





Code
Text
Genes
2017 CLFS
2018 PAMA
1
81410
Aortic dysfunction
9 or more
NA
$504
2
81411
-- Dup, Del
4 or more
NA
$1350
3
81412
Ashkenazi associated gene panel
9 or more
$602.10
$2448
4
81413
Cardiac ion disorders gene panel
10 or more
$802.33
CW to Lynch which ?? Drops to new $38
5
81414
-- Dup, Del
2 or more
$802.33
CW to Lynch Dup Del new $574
6
81415
“Exome”

NA
$4780
7
81416
     Comparator exome

NA
$12,000
8
81417
     Reevaluation of exome

NA
$320
9
81420
Fetal Aneuploidy (maternal blood) (non-branded)
(cf 81507 = Ariosa Harmony = PAMA $795)

$802.33
$759
10
81422
Fetal microdeletions

$802.33
Cont. CW 81436 (Lynch Dup Del, new $574)
11
81425
“Genome”

NA
Never priced and No data; CW to 81445, $600
12
81426
      Comparator genome

NA
Never priced and No data; CW to 81445, $600
13
81427
      Reevaluation of genome

NA
Never priced and No data; CW to 81445, $600 X 50%
14
81430
Hearing Loss
60 or more
NA
$1625
15
81431
-- Dup, Del
2 or more
NA
$679
16
81432
Breast cancer related gene panel
14 or more
$931.48
$136
17
81433
-- Dup, Del
5 or more
$602.10
$425
18
81434
Retinal disorders gene panel
15 or more
$602.10
Cont. CW to 81432, NEW $136
19
81435
Colon cancer related gene panel
10 or more
$802.33
$38
20
81436
-- Dup, Del
5 or more
$602.10
$574
21
81437
Neuroendocrine cancer related gene panel
6 or more
$602.10
$93
22
81438
-- Dup, Del
4 or more
$602.10
$250
23
81439
Inherited cardio-myopathy gene panel
5 or more
$802.33
Cont. CW to 81435 Lynch (New $38)
24
81440
Nuclear encoded mitochondrial genes
100 or more
NA
$3324
25
81442
Noonan spectrum gene panel
12 or more
$602.10
$2143


Tumor Panels:



26
81445
Somatic cancer mutation panel
5-50 genes
$602.10
$597
27
81450
Hematopoietic cancer gene panel
5-50 genes
$652.94
$759
28
81455
Tumor mutation panel
>50 genes
NA
$2919






29
84160
Whole mitochondrial genome

NA
$1287
30
81465
-- Large deletion analysis

NA
$936
31
81470
X-linked disabilities, at least 60 genes

NA
Never priced and no data; CW 81445, NEW $597
32
81471
--Dup Del

NA
Never priced and no data; CW 81433 Dup Del, NEW $425