Some LInks about Gapfill (2/2021)

See main blog to which this article provides background and footnotes - here.

CMS REGULATION

https://www.law.cornell.edu/cfr/text/42/414.508 

x

CMS INFO

Policy up to 2021 and CMS correspondence this year suggests all MACs will price all codes officially put into the Gapfill process.

CMS website says all MACs will price all codes (2/12/2021).

For any new test code that will be gapfilled, we request our MACs to develop MAC-specific gapfilled amounts for each test code and report the amount to CMS by April 1 of the following year. 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/ClinicalLabFeeSched/Laboratory_Public_Meetings  

CMS transmittal for 2020 was here, CR11598:  https://www.cms.gov/files/document/r4498cp.pdf

CMS transmittal for 2021 is here, CR12080:   https://www.cms.gov/files/document/r10575CP.pdf 

MAC INFO

Both NGS MACs and MolDx stated to consultants by email circa 2/2021 that only codes for lab tests in their jurisdictions would be accepted and reviewed for gapfill 2021. (See however points 1,2 above, which is different and suggests CMS needs info for all codes).

MOLDX gapfill worksheet, Excel, webpage, here:

https://www.palmettogba.com/palmetto/MolDX.nsf/docscat/MolDx%20Website~MolDx~Browse%20By%20Topic~Technical%20Assessment~MolDX%20Gapfill%20Worksheet

NOVITAS Gapfill web page here (leads to tabular web portal for data entry):

https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00246106

FCSO Gapfill web page here (leads to tabular web portal for data entry):

https://medicare.fcso.com/Clinical_lab/0456242.asp 

NO OTHER INFORMATION

• NGS MAC had no information on GAPFILL rules or processes or how to submit.
• CGS, WPS, NORIDIAN MACs had no information, separate from MolDx home website, using GAPFILL as a keyword search.   
• Palmetto GBA MAC had no hits for “Gapfill” although there is a webpage, as cited on the MOLDX separate homepage.