January 11, 2016
2016 MoPath Tier 2 Fee Schedule (CM00094)
As per Change Request (CR) 9465, CMS released the 2016 clinical laboratory fee schedule for tests reported with Tier 1 CPT codes. The table below lists the fees established for Tier 2 covered tests. Please note the genes are sorted by CPT code and then by alpha per gene. In Tier 2 codes multiple genes are listed under a single code. The required identifier assigned and submitted with each test enables MolDX to apply the appropriate fee for the specific test performed.
CPT Code | Descriptor | Allowed |
---|---|---|
81400 | ACE, idv | $82.58 |
81400 | F13B, V34L | $64.52 |
81400 | F2, 1199G>A | $70.20 |
81400 | F5, HR2 | $58.84 |
81400 | F7, R353Q | $64.52 |
81400 | FGB, -455G>A | $70.20 |
81400 | HPA, antigen ea | $46.46 |
81400 | IL28B, rs12979860 | $55.23 |
81400 | SERPINE1, 4G | $58.84 |
81401 | ABL1, T315I | $153.01 |
81401 | CYFB_MYH11, cv | $138.82 |
81401 | CCND1_IGH, ta majbp qual qual | $93.94 |
81401 | E2A_PBX1, ta qual quan, | $105.30 |
81401 | EML4_ALK, ta or ia | $128.48 |
81401 | ETV6_RUNX1, ta qual quan | $90.31 |
81401 | EWSR1_ERG, ta qual quan | $151.42 |
81401 | EWSR1_FLI1, ta qual quan | $162.85 |
81401 | EWSR1_WT1, ta qual quan | $203.84 |
81401 | F11, cv | $75.88 |
81401 | FIP1L1_PDGFR, qual quan | $90.82 |
81401 | FOXO1_PAX3, ta, qual quan | $120.75 |
81401 | FOXO1_PAX7, ta, qual quan | $120.75 |
81401 | IGH/BCL2, sbp | $123.36 |
81401 | MUTYH, cv | $105.81 |
81401 | PAX8_PPARG, ta | $54.19 |
81401 | RUNX1_RUNX1T1, ta qual quan | $106.05 |
81401 | TPMT, cv | $111.61 |
81401 | TYMS, trv | $169.10 |
81401 | VWF, cv (2N) | $278.18 |
81402 | IGH_BCL2 majbp & mcr bp | $123.36 |
81402 | KIT, cv | $98.13 |
81403 | CEBPA, fgs | $235.54 |
81403 | EPCAM, kfv | $93.94 |
81403 | F8, intron 1 and 22a | $81.05 |
81403 | IDH1, exon 4 | $67.70 |
81403 | IDH1_IDH2, exon 4 panel | 135.40 |
81403 | IDH2, exon 4 | $67.70 |
81403 | JAK2, exon 12 and 13 | $109.14 |
81403 | MUTYH, kfv | $93.94 |
81403 | RET, kfv | $93.94 |
81403 | VHL, dup_del | $83.60 |
81403 | VWF, tsa | $300.03 |
81404 | CDKN2A, fgs | $373.14 |
81404 | KIT, tga | $213.47 |
81404 | NRAS, exon 1, 2 | $148.04 |
81404 | PDGFRA, tsa | $111.44 |
81404 | PRSS1, fgs | $248.76 |
81404 | RET, cv | $94.97 |
81404 | VHL, fgs | $639.96 |
81405 | MEN1, fgs | $426.32 |
81405 | RET, tsa | $379.47 |
81405 | VWF, tsa 2N | $278.18 |
81406 | RET, fgs | $384.51 |