The health technology firm is proposing a new software solution that would standardize coding in genetic testing, but a more predictable system would also narrow variability in test pricing.
The agency said its aim is to analyze the way CMS has chosen to implement PAMA and to estimate the potential financial impact to Medicare as a result of those choices.
After a GAO report found that CMS may be overpaying for lab tests, the legislator is asking the government payor to explain how it will ensure appropriate use of taxpayer funds.
In a letter to CMS, AMP made a case for crosswalking existing CPT codes for BRCA1/2 testing to codes that more accurately reflect the work required to analyze these genes.
The firm has struggled in the past to convince payors of its test's clinical utility but remains dedicated to convincing the field that Epi proColon can help patients by closing CRC screening gaps.
The unique, test-specific PLA codes make it easier for insurers to identify tests and apply positive or negative coverage policies, billing experts say.
Since last year the AMA has issued 23 PLA codes for firms that want to better track use of their tests, but the effect of the codes on improving reimbursement remains to be seen.
The panel's decisions could change the codes diagnostic companies use to bill payors for these tests, which could affect revenue.