AMP Symposium on Coding, Coverage, and Reimbursement of Molecular Diagnostic Tests Economic Affairs Committee symposium at the AMP Annual Meeting in Austin, Texas

Newswise — Bethesda, MD, November 10, 2015: The Association for Molecular Pathology (AMP), the premier global, professional society serving molecular diagnostics professionals, today reported the results of a dynamic symposium, “Coding, Coverage, and Reimbursement of Molecular Diagnostic Tests in Today’s Healthcare Landscape” held November 6, 2015 at AMP’s annual meeting in Austin, Texas. The symposium was organized by AMP’s Economic Affairs Committee (EAC).

At the symposium, Aaron D. Bossler, MD, PhD, 2015 EAC Chair, gave an overview of AMP’s initiatives to communicate with payers in order to obtain adequate coverage and payment for molecular pathology procedures, including genomic sequencing procedures (GSPs). Dr. Bossler reported that the AMP EAC has worked diligently to respond to numerous incomplete or inadequate Medicare Administrative Contractor (MAC) local coverage determinations, and they continue to seek ways to improve these policies by providing the MACs with genomic medicine expertise. Dr. Bossler also reviewed one of the EAC’s biggest initiatives from 2015 — the Genomic Sequencing Procedures Cost and Value Project. These models were developed as tools for laboratories to effectively communicate to public and private payers the cost and value of GSP services.

“Unfortunately, the Centers for Medicare and Medicaid Services (CMS) has chosen to utilize the gapfill process to determine pricing with respect to the new GSP CPT codes,” said Dr. Bossler. “The process results in long delays in obtaining pricing information, leads to denials of coverage decisions and undervalues laboratory costs. This creates a challenging environment for clinical practice and for innovators to translate new genomic discoveries into clinical applications.”

The session included presentations from various leaders in the field, all of whom are very knowledgeable regarding reimbursement for molecular diagnostic tests. Rina Wolf, MHA, XIFIN, Inc., gave a “real world” view of current factors influencing payment for molecular diagnostics, including the recently released Protecting Access to Medicare Act (PAMA) proposed rule and its scheduled implementation. John Pfeifer, MD, PhD, provided an overview of the process his laboratory used to achieve sustainable reimbursement for next generation sequencing (NGS) tests and Erick Lin, MD, PhD, Ambry Genetics, provided advice on successfully working with payers. Two major themes of both Dr. Pfeifer's and Dr. Lin’s talks were that one-on-one payer engagement and communication are essential, which they both agreed take significant time. In addition, they noted that payers want to be assured that the testing is accurate and results in improved patient outcomes.

After the presentations, Samuel K. Caughron, MD, 2016 EAC Chair, led a panel discussion on successful communication strategies between diagnostics laboratories and payers.

“Hampering the success of our reimbursement education efforts is the emergence of non-coverage decisions for multi-gene sequencing assays,” said Dr. Caughron. “Defining and addressing the issues that prevent important clinical lab testing from being available to our patients will continue to be a major advocacy focus for AMP in 2016.”

ABOUT AMPThe Association for Molecular Pathology (AMP) was founded in 1995 to provide structure and leadership to the emerging field of molecular diagnostics. AMP's 2,300+ members include individuals from academic and community medical centers, government, and industry; including pathologist and doctoral scientist laboratory directors; basic and translational scientists; technologists; and trainees. Through the efforts of its Board of Directors, Committees, Working Groups, and members, AMP is the primary resource for expertise, education, and collaboration in one of the fastest growing fields in healthcare. AMP members influence policy and regulation on the national and international levels, ultimately serving to advance innovation in the field and protect patient access to high quality, appropriate testing. For more information, visit

CONTACT:Rick Roose, on behalf of AMPBioscribe Life Science CommunicationsRick@bioscribe.com415-202-4445