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January 11, 2016

2016 MoPath Tier 2 Fee Schedule (CM00094)

As per Change Request (CR) 9465External PDF, 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

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