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Myriad Genetics (MYGN) Updates on New CMS NLA Amount for BRCA 1, 2

December 30, 2013 6:36 AM EST
On September 30, 2013, the Centers for Medicare & Medicaid Services (CMS) posted a National Limit Amount (NLA) of $2,795.09 for CPT code 81211, which covers a test for the full sequencing of the BRCA 1 and 2 genes and $1,449.01 for CPT code 81214, which covers a test for the full sequencing of only the BRCA 1 gene. On November 29, 2013, CMS posted an NLA of $1,438.14 for CPT code 81211 and the same amount for CPT code 81214. There is no payment rate for code 81216, which covers a test for the full sequencing of the BRCA 2 gene. The new payment rate for CPT codes 81211 and 81214 will be effective for tests performed on or after January 1, 2014. As the public has not had the opportunity to provide comment on the new NLA for 81211, on December 27, 2013 CMS announced that it is providing an additional public comment period through January 27, 2014. It is unclear why CMS has not valued the BRCA 2 gene in the 81211 code. It is also unclear how CMS arrived at the 81211 payment rate within the requirements of the federal gapfill regulations. We will be commenting during the new public comment period to address a number of both substantive and process concerns.


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