Molecular Pathology Reimbursement

Active laboratory participation is needed now to ensure sustainable reimbursement in 2013 and beyond.

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.

Education

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.

Learn more about MoPath codes »

Codes for Next-Generation Sequencing–Based Assays

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.

Learn more about the new codes for NGS-based assays »

Webinars

A webinar series designed to educate molecular diagnostic test providers on the new MoPath codes, how they were developed, how they can be used, and introduce future MoPath codes.

View the webinars »

Resources

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.

Read the summaries and recommendations »

MoPath Codes for NGS Assays

MoPath Codes for NGS Assays Timeline

New MoPath codes for next-generation sequencing–based assays are already under development.
View the timeline »

Webinar: Molecular Pathology Reimbursement in 2013–2014

Molecular Pathology Reimbursement in 2013

Understand the 114 new MoPath codes implemented in 2013 and their implications for 2014.

View the webinar »

Illumina is providing this review of the molecular pathology reimbursement landscape in collaboration with Quorum Consulting for educational purposes only. The content should not be considered legal advice. For official ruling on the MoPath codes readers should consult CMS, the AMA, and other sources as appropriate.