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Industry groups and vendors press CMS panel for multiple crosswalks and gap-fill decisions across emerging test codes
Summary
Trade groups (ACLA, ASM, AdvaMed) and multiple vendors presented crosswalk and gap-fill recommendations for a wide range of new CPT/PLA codes, urging CMS to consider assay methodology and resource use when assigning rates.
Representatives from the American Clinical Laboratory Association, the American Society for Microbiology and industry groups presented a slate of crosswalk and gap-fill recommendations across many CPT/PLA codes, asking CMS to align payment with stated laboratory resource requirements.
Topics included proposed gap-fill for multi-gene resistance and susceptibility testing (e.g., five-gene resistance panels), crosswalks for GFAP neurotrauma assays, new multiplex infectious-agent codes (Candida pooled with glabrata and trichomonas callouts), and PLA crosswalk proposals for various oncology and neurology panels. Presenters argued that methodology, specimen type and analytical complexity—not just gene counts—should drive crosswalk decisions.
Why it matters: Broad association submissions can influence CMS's approach to coding and pricing across many new tests. ACLA and ASM advocated gap-fill where no appropriate comparator exists, and AdvaMed reiterated several crosswalk suggestions previously presented by manufacturers.
Panelists used the session to flag codes that may require deeper resource analyses. CMS staff closed the session by asking presenters to submit written follow-up by the stated deadline.
