Here.
Most, though not all, have a triplet of PDFs of Draft LCD, Comment Article, and Final LCD.
The table below is small print but click to enlarge, it's an overview of the contents.
 |
| click to enlarge |
Sunday, March 31, 2019
Cloud Zip File - 17 MolDx Recent LCDs (Draft, Comment, Final)
From the Noridian Draft LCD website, about 17 folders in a zip file in the cloud.
Here.
Most, though not all, have a triplet of PDFs of Draft LCD, Comment Article, and Final LCD.
The table below is small print but click to enlarge, it's an overview of the contents.
Here.
Most, though not all, have a triplet of PDFs of Draft LCD, Comment Article, and Final LCD.
The table below is small print but click to enlarge, it's an overview of the contents.
Thursday, March 28, 2019
MolDx New LCDs May 6 2019
| PROPOSED LCD ID # | PROPOSED LCD TITLE | CONTRACTOR NAME | PROPOSED STATUS | COMMENT PERIOD START DATE | COMMENT PERIOD END DATE** | DATE OF RELEASE FOR NOTICE | |
|---|---|---|---|---|---|---|---|
| DL38026 | Corneal Hysteresis | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38029 | MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Unfavorable Intermediate Risk Disease | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38033 | Cervical Disc Replacement | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38035 | MolDX: Decipher® Biopsy Prostate Cancer Classifier Assay for Men with Favorable Intermediate Risk Disease | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38037 | Lab: Drug Interaction Testing | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38039 | MolDX: TruGraf Blood Gene Expression Test | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38041 | MolDX: Prospera | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38043 | MolDX: Guardant360® Plasma-Based Comprehensive Genomic Profiling in Solid Tumors | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38045 | MolDX: Next-Generation Sequencing for Solid Tumors | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38047 | MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies | Palmetto GBA | D | 5/6/2019 | 6/20/2019 | ||
| DL38051 | MolDX: Pigmented Lesion Assay | ||||||
Thursday, March 14, 2019
CMS Hospital Outpatient Circumcision
I was making the point that CMS usually gives outpatient (APC) coding and pricing to any procedure, even if it is uncommon under Medicare.
54150 is circumcision, any age, clamp. 54160 is other method, <28d, and 54161 is other method, >28d. These are coded in APC 5373, $1739, except for 54160, which is APC 5372, $562.
Leaving aside CMS, the AMA RVU for 54150 is $159 (office, $101 facility). CMS utilization was 237 in 2017, 70% outpatient, 11% inpatient, 10% office.
AMA RVU for 54160 is $227 (office, $150 facility). Recall this is "<28d" of age. CMS utilization was 4 in 2017, having peaked at 17 in 2007.
54161 was by far the busiest code. Payment is $205, facility only, with utilization in 2017 at 9,294. 85% were beneficiaries by age (15% by disability or ESRD). The main diagnosis code was N47 (disorder of prepuce), and location was 72% outpatient, 18% ASC, 5% inpatient, 3% office. 98% of surgeons were urologists.
___
I haven't research all the various L&D codes further, but code 59400 for antepartum care & normal L&D had 3,383 uses in CY2017. RVU's tally $2177 for 739 minutes (12 hours) of MD time. With antepartum care and cesarean, 54510, $2414, for 817 minutes, with 2,853 uses in CY2017.
54150 is circumcision, any age, clamp. 54160 is other method, <28d, and 54161 is other method, >28d. These are coded in APC 5373, $1739, except for 54160, which is APC 5372, $562.
Leaving aside CMS, the AMA RVU for 54150 is $159 (office, $101 facility). CMS utilization was 237 in 2017, 70% outpatient, 11% inpatient, 10% office.
AMA RVU for 54160 is $227 (office, $150 facility). Recall this is "<28d" of age. CMS utilization was 4 in 2017, having peaked at 17 in 2007.
54161 was by far the busiest code. Payment is $205, facility only, with utilization in 2017 at 9,294. 85% were beneficiaries by age (15% by disability or ESRD). The main diagnosis code was N47 (disorder of prepuce), and location was 72% outpatient, 18% ASC, 5% inpatient, 3% office. 98% of surgeons were urologists.
___
I haven't research all the various L&D codes further, but code 59400 for antepartum care & normal L&D had 3,383 uses in CY2017. RVU's tally $2177 for 739 minutes (12 hours) of MD time. With antepartum care and cesarean, 54510, $2414, for 817 minutes, with 2,853 uses in CY2017.
Wednesday, March 13, 2019
T2 - Infectious Disease Molecular Diagnostics - 201812 CMS NTAP and 201901 PAC CARB
This is my document archive blog. For my regular blog see www.discoveriesinhealthpolicy.com .
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T2 Biosystems is a Massachusetts based molecular diagnostics company focused on culture-free blood-based detection of pathogens. This allows rapid direct molecular pathogen ID before culture, and facilitates assignment of correct antibiotic classes in cases of sepsis. Product T2Direct.
T2 presented at CMS in December 2018 for a New Technology Add On Payment (NTAP). T2 also presented at PAC CARB in January 2019, representing the potential and the challenges of a startup company in the infectious disease space.
In a zip file in the cloud, I've placed four documents:
201812: One pager summarizing T2 NTAP application, and unofficial transcript with screen shots of their ten minute presentation.
201901: Ten page PDF deck and one hour transcript of their presentation at PAC CARB.
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Another innovative company in this space is Accelerate Diagnostics with the "Accelerate Pheno" system. Here. Once a culture is positive, this produce produces rapid antibiotic sensitivity profiles in a few hours.
As of March 2019, AXDX has a market cap of $1.1B. (5-year, $11 to $28, $20 current; 4Q2018 revenue $5.6M, income -$88M.) TTOO has a market cap of $125M (5-year, $23 to $2.80 current, 4Q108 revenue $10M, income -$50M.)
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