The Molecular Pathology (MoPath) coding system developed by the Centers for Medicare & Medicaid Services went into effect in January of 2013. Associated rates have now been published. These rates are effective for claims submitted to Medicare Administrative Contractors (MACs) through December 31, 2013, and will apply to claims submitted in 2014.
Reimbursement coding for clinical laboratories performing molecular diagnostic tests have recently changed. The new Molecular Pathology (MoPath) codes now reflect the purpose of the test instead of the methods used. This section provides background on what MoPath codes are, how the codes are developed, and how physicians use the codes for billing.
The Association for Molecular Pathology (AMP) has proposed new MoPath codes specific to assays based on next-generation sequencing (NGS) technology. These are currently under development, with potential implementation in January 2015.
A number of resources are available to help you understand the current MoPath codes and the rate-setting process. These include details on reimbursement for cytogenomic and cystic fibrosis testing, references on Medicare laboratory reimbursement, and practice guidelines from ACMG and ACOG.
New MoPath codes for next-generation sequencing–based assays are already under development.
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Understand the 114 new MoPath codes implemented in 2013 and their implications for 2014.