As of 12/10/2015:
Notice of CPT Editorial Panel Planning Session Regarding New Section of CPT Related to PAMA
You are invited to a telephone meeting sponsored by the CPT Editorial Panel on Tuesday, December 15, 2015, from 7 p.m. to 9 p.m. CST for input from all interested stakeholders about the new CPT clinical laboratory test section. Topics to be covered include (a) relevant background of the PAMA proposed rule; (b) the CPT Editorial Panel’s initial response to create the new section in CPT and potential plans for implementation; and (c) the opportunity for stakeholders to provide comments and recommendations for the CPT Editorial Panel to consider. This will be a planning session for the CPT Editorial Panel and not a formal Panel meeting for consideration of a code change proposal. Instead, this meeting will help guide the CPT Editorial Panel and CPT staff in generating the code change proposal to be considered by the Panel at a future public meeting and the already-planned February CPT Editorial Panel meeting. The AMA encourages all interested stakeholders to engage in the discussion to help achieve a consensus-driven coding solution that meets the needs of a broad cross section of stakeholders.
If you wish to participate, please email firstname.lastname@example.org as soon as possible. You will need to complete a Confidentiality and Copyright Assignment form and return it no later than December 8, 2015. Please email or fax (312-224-6916) the form to Judy. After this date, we will be unable to add you to the security list for access to the call.
CPT Editorial Panel Authorizes the Establishment of a New Clinical Laboratory Test Section
The Protecting Access to Medicare Act of 2014 (PAMA) mandates the creation of specific HCPCS codes for Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) that are cleared or approved by the Food and Drug Administration (FDA). Over the past year, the Molecular Pathology Coding Workgroup (MPCW) of the CPT Editorial Panel (Panel) has hosted public meetings with stakeholders to discuss potential CPT coding solutions that could meet the statutory coding requirements in PAMA.
On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed the creation of G codes to identify new and existing ADLTs and new and existing CDLTs (that are not ADLTs) that are cleared or approved by the FDA if a specific HCPCS code does not already exist. In addition, the proposed rule provides that use of the existing HCPCS system—comprised of CMS HCPCS Level II codes and HCPCS Level I CPT codes—does not require additional unique identifiers. Further, the Agency proposes to expressly prohibit the use of unlisted and Not Otherwise Classified (NOC) codes for purposes of reporting private payer rates under PAMA. As noted by the CMS, G codes are temporary HCPCS Level II codes used by CMS to identify professional health care procedures and services, including laboratory tests that would otherwise be identified by a CPT code, but for which there is no CPT code.
In early October, the MPCW held a public meeting during the regularly scheduled Panel meeting in order to solicit additional input and feedback on an appropriate coding solution that would ensure consistent and accurate coding for all stakeholders including payers, providers, and clearinghouses. In early November, the Panel authorized the establishment of a new section in the CPT code set. The new section established by the Panel provides an infrastructure whereby a clinical laboratory or manufacturer that meets certain criteria may request a code to more specifically identify their test. This section is separate from the Category I Pathology and Laboratory section and will include ADLTs and CDLTs as defined under PAMA. The clinical laboratory or manufacturer that offers the test must request the code.
It is envisioned that the codes in this new section will be issued on a quarterly basis and effective the following quarter to allow payers time to load them into their systems. The Panel would be responsible for verification of the information submitted and codification of tests in this section. The Panel will not determine whether or not the test meets the criteria of an ADLT, which will be determined by CMS.
This new section provides a sustainable coding infrastructure utilizing an established, transparent process that will ensure consistent national coding across Medicare and other public and private payers. This solution represents the longstanding commitment of the Panel to ensure the CPT code set provides a uniform language and meets the needs of a broad cross-section of stakeholders.