Pricing Myriad's Genesight vs Other Psychiatric Panel Tests

In a September 16, 2020 blog, I noted that Nephron Research had, through a FOIA request, determined that the Myriad Genesight test had been repriced by MolDx at a new lower price of $1569 - here.

This documents blog lists some comparable tests and where they stand.

0078U - $450

Last year, on the CLFS fee schedule, CMS priced the pain pharmacogenetic panel 0078U.  It was priced by CMS by the "crosswalk" method, at $450.91.

The AMA CPT code book gives the origin of this test.  It's attributed to the INFINITI Neural Response Panel, PeersonzeDx Labs, AutoGenomics Inc.  The text is "pain management (opioid-use disorder), genotyping panel, 16 common variants (ie ABCB1...OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid use disorder.

0173U and 0175U - In the Current Crosswalk-Setting Process

Two similar psychiatric gene panel codes are in the current (summer/fall 2020) price-setting process at CMS.  Proposed prices were released by CMS in September, and final prices for CY2021 will be released by CMS in November.

Test 0173U is the Psych HealthPGx Panel, RPRD Diagnostics, described as "psychiatry (ie depression, anxiety), genomic analysis panel, includes variant analysis of 14 genes."

Test 0175U is the Genomind Professional PGx Express CORE, Genomind, Inc, described as "psychiatry (e.g. depression, anxiety), genomic analysis panel, variant analysis of 15 genes."

Although these two tests have similar descriptors, the CMS lab test advisory panel in July recommended different pricing for them.  For 0173U, 11 recommended gapfill.  For 0175U, 8 recommended crosswalk to 0078U, and 4 recommended gapfill.  (While 0078U is not so similar to Genesight, 0175U is, and 8 national expert panelists recommended crosswalking 0175U to 0078U).

CMS proposed in September that both 0173U and 0175U be priced by the CMS gapfill process during CY2021.  Because they are too new, they don't have any current CLFS price now in 2020.

Other Possible Comparators

Other comparators would be further afield, but may be relevant.  

81432, for example, is sequencing of a panel of 10 or more genes, including BRCA1-2, related to breast cancer.  That's a lot of sequencing of a lot of genes.  CMS prices 81432 at $679, much less than $1569.  BRCA and related genes sometimes use copy number (dup del) analysis, which pays an extra $439 as code 81433 (totalling $1118 this year, still quite a bit less than $1569).

One could argue that the Genesight test involves algorithmic analysis not used by 81432/81433.  However, Palmetto said in its final pharmacogenetics LCD  in summer 2020 that it was not giving credit for (finding value in) the "algorithmic"  component of psychiatric gene panel tests.  See CMS LCD L38335.  Writing: "Based on our review of the evidence and on expert feedback submitted both during the CAC meeting and during the comment period for this policy, it’s been determined that there are insufficient data to support coverage for any combinatorial test."