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Calendar Year 2015 – New Clinical Laboratory Fee Schedule (CLFS) Test Codes and Final Gapfill Payment Determinations

Last week CMS released preliminary pricing determinations for 2016 for a number of lab tests described by new CPT codes, as well as several multi-analyte algorithm-based assays (MAAA). CMS determines lab test pricing using the so-called gapfill process, when no comparable technology exists, or the crosswalk method, which correlates payment to rates for comparable technologies and CPT codes. For the majority of MAAAs that the government payor considered, it used the crosswalk method, spurring objections from labs that pricing using this process fails to capture the value of their tests.