Failure to Pay for New Molecular CPT Codes Created Money Crisis for Clinical Laboratories and Pathology Groups

Confusion, unhappiness, and many unresolved issues remain about the way government and private payers are handling claims for molecular diagnostic tests covered by the 114 new CPT codes
Dust is settling from the fiasco triggered by the Medicare program’s failure to be ready on January 1, 2013, to settle molecular diagnostic test claims filed under the 114 new Tier 1 and Tier 2 molecular CPT codes. The damage is not just limited to Medicare test claims, but also involves private health plans that were waiting to let the Medicare program set precedents on coverage and prices for the new molecular test codes.

Many Clinical Laboratories Must Cope With an Unsatisfactory Situation

Although federal Medicare officials and Medicare contractors have scrambled to rectify the situation, even today there is much unhappiness across the clinical laboratory industry about the current state of things. That unhappiness extends to state Medicaid and private payers because many of these payers have been slow to publish coverage guidelines and prices for these new molecular test CPT codes.


Two Pathology Lab Deals Launch the New Year, One is Worth $100 Million

PathGroup of Nashville raises $100 million; OncoDiagnostic Laboratory is acquired

For the business of anatomic pathology, the new year got off to a fast start with two different deals announced yesterday. The biggest transaction was major capital infusion at PathGroup, Inc., one of the nation’s regional pathology supergroups. The other transaction was the acquisition of a pathology group practice in Cleveland, Ohio, by Predictive Biosciences, Inc., of Lexington, Massachusetts.

Yesterday, PathGroup, Inc., of Brentwood, Tennessee, announced a leveraged recapitalization which raised more than $100 million for the pathology services company. This transaction signals a shift in the business strategy for one of the nation’s larger pathology laboratory companies and gives it an ample war chest to fund acquisitions, as well as further expansion of its ongoing lines of laboratory testing.