Wednesday, April 26, 2017

MolDX Tier 2 pricing as of April 2017

http://www.palmettogba.com/palmetto/moldx.nsf/docscat/MolDx%20Website~MolDx~Browse%20By%20Topic~General~2016%20MoPath%20Tier%202%20Fee%20Schedule%20(M00005%20V9)


Captured 4/2017.

2016 MoPath Tier 2 Fee Schedule (M00005, V9)


As per Change Request (CR) 9465, CMS released the 2016 clinical laboratory fee schedule for tests reported with Tier 1 CPT codes. The table below lists the fees established for Tier 2 covered tests. Please note the genes are sorted by CPT code and then by alpha per gene. In Tier 2 codes multiple genes are listed under a single code. The required identifier assigned and submitted with each test enables MolDX to apply the appropriate fee for the specific test performed.  
HCPCS Code
Descriptor
Allowed
81400
ACE, idv
$82.58
81400
F13B, V34L
$64.52
81400
F2, 1199G>A
$70.20
81400
F5, HR2
$58.84
81400
F7,  R353Q
$64.52
81400
FGB,  -455G>A
$70.20
81400
HPA, antigen ea
$46.46
81400
IL28B, rs12979860 
$55.23
81400
SERPINE1, 4G
$58.84
81401
ABL1, T315I
$153.01
81401  
CYFB_MYH11, cv  
$138.82 
81401
CCND1_IGH, ta majbp qual qual
$93.94
81401
E2A_PBX1, ta qual quan,
$105.30
81401
EML4_ALK, ta or ia
$128.48
81401
ETV6_RUNX1, ta qual quan
$90.31
81401
EWSR1_ERG, ta qual quan
$151.42
81401
EWSR1_FLI1, ta qual quan
$162.85
81401
EWSR1_WT1, ta qual quan
$203.84
81401
F11, cv
$75.88
81401
FIP1L1_PDGFR, qual quan
$90.82
81401
FOXO1_PAX3, ta, qual quan
$120.75
81401
FOXO1_PAX7, ta, qual quan
$120.75
81401IGH/BCL2, sbp $123.36 
81401
MUTYH, cv
$105.81
81401
PAX8_PPARG, ta
$54.19
81401
RUNX1_RUNX1T1, ta qual quan
$106.05
81401
TPMT, cv
$111.61
81401
TYMS, trv
$169.10
81401
VWF, cv (2N)
$278.18
81402
IGH_BCL2 majbp & mcr bp
$123.36
81402
KIT, cv
$98.13
81403 
CEBPA, fgs  
$235.54 
81403
EPCAM, kfv
$93.94
81403
F8, intron 1 and 22a
$81.05
81403
IDH1, exon 4
$67.70
81403 IDH1_ IDH2, exon 4 panel 135.40 
81403
IDH2, exon 4
$67.70
81403
JAK2, exon 12 and 13
$109.14
81403  
MUTYH, kfv $93.94 
81403
RET, kfv
$93.94
81403
VHL , dup_del
$83.60
81403
VWF, tsa
$300.03
81404
CDKN2A, fgs
$373.14
81404
KIT, tga
$213.47
81404
NRAS, exon 1, 2
$148.04
81404
PDGFRA, tsa
$111.44
81404
PRSS1, fgs
$248.76
81404
RET, cv
$94.97
81404
VHL, fgs
$639.96
81405
MEN1, fgs
$426.32
81405 RET, tsa $379.47 
81405
VWF, tsa 2N
$278.18
81406
RET, fgs
$384.51

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