Radensky Watching and Waiting for Codes

January 06, 2015


Clinical laboratories will be watching and waiting in the new year for the Centers for Medicare and Medicaid Services (CMS) to resolve several unsettled issues concerning coding for drug-screening tests. CMS approved 21 new codes for advanced genomic studies such as exome sequencing and whole genome sequencing, as well as a range of hereditary and cancer/somatic mutation genetic panels.


CMS added that it will instead replace the 2014 CPT codes for [drug screening] tests with “G” codes … The temporary G codes may not be accepted by private payers, while the CPT codes are valid and effective whether Medicare recognizes them or not … “It’s inefficient,” Paul W. Radensky, M.D., J.D., … “For example, with the definitive drug testing codes, under the new codes for 2015, one may have three codes for a certain analyte based upon how many different specific drugs you have within that kind of grouping, whereas the under CPT 2014 now carried forward as G codes for Medicare there may be only one code. Where this occurs, there will be one code to report to Medicare but multiple codes to report to private payers,” Dr. Radensky added.

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