CMS extends the laboratory date of service exception to apply to cancer-related protein-based MAAAs in CY 2021 OPPS Final Rule

This evening, CMS released CY 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule. As part of this final rule, CMS finalized the extensions of the laboratory date of service exception. Specifically, CMS expanded the laboratory DOS exception to include cancer-related protein-based MAAAs, such as CPT codes 81500, 81503, 81535, 81536, and 81539. This exception is not limited to the current MAAAs, and it will apply to MAAAs that are developed in the future. In response to stakeholder feedback, CMS also finalized an exception to the DOS policy for the test described by the CPT code 81490, a test for rheumatoid arthritis. The DOS exception will not apply to PLA codes that seem MAAA-like at this time, but CMS may revisit this policy in the future when patterns of utilization are better understood.

Hospital Outpatient Prospective Payment- Notice of Final Rulemaking with Comment Period (NFRM)