Lawmakers urge CMS to publically discuss MDx rates

A bipartisan group of 27 lawmakers from the U.S. House of Representatives sent a letter to CMS asking the agency to hold a public meeting on how Medicare administrative contractors (MACs) determined interim reimbursement rates for existing molecular diagnostics. Last year, CMS moved to a system where an individual molecular test is assigned a unique billing code. CMS delegated to MACs -- the regional contractors that make the vast majority of payment decisions for CMS -- the task of setting interim reimbursement rates for existing molecular tests. The agency (see BioCentury, July 15).

According to the letter, some MACs set reimbursement rates for molecular tests without providing any background or methodology on how they arrived at the rate, and some CPT codes have reimbursement rates that are below the cost of providing the test. Additionally, the letter notes that MACs are still denying coverage for some molecular diagnostics or have delayed payment to laboratories, which prevented stakeholders from "providing meaningful feedback" on the interim rates. ...