July 7 2026
91 FR 41734 OPPS Proposed Cy2027
In Table 62, CMS lists tests that will be pulled off the CLFS fee schedule (and policy system) and into the general APC services, with pricing for now via New Tech crosswalk prices.
0510U is basically a MAAA mRNA test where the mRNAs have been previously measured (perhaps a tumor test that includes a whole transcriptome), 16 mRNA levels x algorithm, $450 [New Tech].
Turning to slides, 0418U is imaging (WSI) of 8 histo and IHC features, APC $750. (This is one of a number of tests priced at $703).
0220U is 12 hiso & IHC features, priced as $750 [New Tech].
0295U sounds similar, but is not included for repositioning. It may be that 0295U includes the slide creation steps, making it more similar to a traditional MAAA. But it is not always clear from the PLA text whether a slide list enumerated in the PLA code represents slides created for the test (and priced-in) or slides previously made and signed out and billed, and just used as input for the provided algorithm.
0295U / ADLT / Oncology (breast ductal carcinoma in situ), protein expression profiling by immunohistochemistry of 7 proteins (cox2, foxa1, her2, ki-67, p16, pr, siah2), with 4 clinicopathologic factors (size, age, margin status, palpability), utilizing formalin-fixed paraffin-embedded (ffpe) tissue, algorithm reported as a recurrence risk score
