2023 Gapfill Request
National Government Services, the MAC for JK and J6 is in receipt of the new laboratory test codes identified by the CMS to be gap-fill priced for 2023. The PAMA regulations instruct the MACs to establish local payment amounts for the new laboratory test codes using the following sources of information, if available:
- Charges for the test and routine discounts to charges
- Resources required to perform the test
- Payment amounts determined by other payors
- Charges, payment amounts and resources required for other tests that may be comparable or otherwise relevant
NGS seeks your input on establishing pricing under the Medicare program for new laboratory test codes: 81418, 86409, 86413, 87428, 0022U, 0285U, 0291U, 0292U, 0297U, 0299U, 0300U, 0301U, 0302U, 0303U, 0304U, 0305U, 0306U, 0307U, 0314U, 0315U, 0318U, 0319U, 0320U, 0326U, 0329U, 0331U, 0332U, 0333U, 0337U, 0338U, 0341U, 0344U, 0346U. NGS kindly requests that you submit your responses to firstname.lastname@example.org by 2/17/2023.
Please note that your answers will be kept to the greatest degree of confidentiality and will not be disclosed, except as may be necessary to share with others under confidentiality agreements with CMS for the sole purpose of establishing Medicare clinical laboratory fee schedule gap filling pricing.
Your responses will be reviewed and evaluated by NGS and if proper, set forth in its recommendations to CMS of the appropriate fees for these tests. If no response is received, the fee will be determined by evaluating the charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant.
Note: The presence of an established local payment amount does not imply coverage.