Mopath Code Fees by Payor

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The following analysis identifies Medicare Administrative Contractor published payor allowed amounts for MoPath CPT Codes. Payors and amounts are updated as they become available. XIFIN customers can log in to access a more detailed analysis that includes actual average allowed amounts received from 3rd party Private Payors.

In response to industry outcry about the new MoPath fees, Palmetto has agreed to review information and evidence supporting a change. To that end, Palmetto has requested that laboratories get together to aggregate their data and provide it all in one set, and the California Clinical Laboratory Association (CCLA) has requested that XIFIN serve as the point of collection and consolidator of the information. CCLA encourages nonmembers to participate in this activity in order to provide a more robust data set, and we are aggregating data for both CCLA members and non-CCLA labs. To participate, please complete the Data Aggregation Spreadsheet for Palmetto and return it to kfetter@xifin.com. For any questions about this process, please contact Kyle Fetter. You can read our blog for our latest thoughts on the evolving issue of MoPath codes, and to join the conversation.

*Indicates no published amounts; figure shown is amount that was paid to one or more labs on the XIFIN system.

CPT Code Short Description Cahaba TN Allowable Palmetto Allowable NHIC* Allowable Noridian Allowable Cigna GS Allowable NGS (CT, NY) Allowable Novitas Allowable Average Allowed
81200 ASPA GENE $ 123.00 $ 93.90 $ -     Available to XIFIN Customers
81201 APC GENE FULL SEQUENCE $ 123.00 $ 749.92 $ 671.18 $ 749.92     Available to XIFIN Customers
81202 APC GENE KNOWN FAM VARIANTS $ 123.00 $ 93.94 $ 84.08 $ 93.94     Available to XIFIN Customers
81203 APC GENE DUP/DELET VARIANTS $ 123.00 $ 570.05 $ 510.19 $ 570.05     Available to XIFIN Customers
81205 BCKDHB GENE $ 205.00 $ 123.36 $ -     Available to XIFIN Customers
81206 BCR/ABL1 GENE MAJOR BP $ 123.00 $ 108.37 $ 96.99 $ 108.37 $48.04 $ 108.37 Available to XIFIN Customers
81207 BCR/ABL1 GENE MINOR BP $ 123.00 $ 90.31 $ 80.83 $ 90.31 $48.04 $ 90.31 Available to XIFIN Customers
81208 BCR/ABL1 GENE OTHER BP $ 123.00 $ 150.17 $ 134.40 $ 150.17   $ 150.17 Available to XIFIN Customers
81209 BLM GENE $ 123.00 $ 93.90 $ -     Available to XIFIN Customers
81210 BRAF GENE $ 123.00 $ 57.51 $ 51.47 $ 57.51     Available to XIFIN Customers
81211 BRCA1&2 SEQ & COM DUP/DEL $ 2,900.00 $ 2,795.09 Available to XIFIN Customers
81212 BRCA1&2 185&5385&6174 VAR $ 205.00 $ 178.04 Available to XIFIN Customers
81213 BRCA1&2 UNCOM DUP/DEL VAR $ 650.00 $ 587.12 Available to XIFIN Customers
81214 BRCA1 FULL SEQ & COM DUP/DEL $ 1,200.00 $ 1,449.01 Available to XIFIN Customers
81215 BRCA1 GENE KNOWN FAM VARIANT $ 50.00 $ 93.94 $ 84.08 $ 93.94     Available to XIFIN Customers
81216 BRCA2 GENE FULL SEQUENCE $ 1,200.00 Available to XIFIN Customers
81217 BRCA2 GENE KNOWN FAM VARIANT $ 50.00 $ 93.94 $ 84.08 $ 93.94     Available to XIFIN Customers
81220 CFTR GENE COM VARIANTS $ 1,200.00 Available to XIFIN Customers
81221 CFTR GENE KNOWN FAM VARIANTS $ 123.00 $ 93.94 $ -     Available to XIFIN Customers
81222 CFTR GENE DUP/DELET VARIANTS $ 123.00 Available to XIFIN Customers
81223 CFTR GENE FULL SEQUENCE $ 1,200.00 $ 1,554.46 $ -     Available to XIFIN Customers
81224 CFTR GENE INTRON POLY T $ 235.00 $ 82.58 $ -     Available to XIFIN Customers
81225 CYP2C19 GENE COM VARIANTS $ 305.00 $ 135.26 $ 121.06 $ 135.26     Available to XIFIN Customers
81226 CYP2D6 GENE COM VARIANTS $ 50.00 $ 147.50 $ 132.01 $ 147.50     Available to XIFIN Customers
81227 CYP2C9 GENE COM VARIANTS $ 50.00 $ 96.78 $ 86.62 $ 96.78     Available to XIFIN Customers
81228 CYTOGEN MICRARRAY COPY NMBR $ 123.00 $ 646.14 $ -     Available to XIFIN Customers
81229 CYTOGEN M ARRAY COPY NO&SNP $ 2,900.00 $ 675.56 $ -     Available to XIFIN Customers
81235 EGFR GENE COM VARIANTS $ 123.00 $ 116.25 $ 104.04 $ 116.25     Available to XIFIN Customers
81240 F2 GENE $ 50.00 $ 41.41 $ 41.41 $ 37.06 $ 41.41 $ 41.41 $ 41.41 Available to XIFIN Customers
81241 F5 GENE $ 50.00 $ 68.64 $ 60.41 $ 61.43 $ 68.64 $ 60.41 $ 68.64 Available to XIFIN Customers
81242 FANCC GENE $ 123.00 $ 93.90 $ -     Available to XIFIN Customers
81243 FMR1 GENE DETECTION $ 123.00 $ 60.51 $ -     Available to XIFIN Customers
81244 FMR1 GENE CHARACTERIZATION $ 123.00 $ 100.09 $ -     Available to XIFIN Customers
81245 FLT3 GENE $ 123.00 $ 112.00 $ 100.24 $ 112.00     Available to XIFIN Customers
81250 G6PC GENE $ 123.00 $ 93.90 $ 84.04 $ -     Available to XIFIN Customers
81251 GBA GENE $ 123.00 $ 93.90 $ 84.04 $ -     Available to XIFIN Customers
81252 GJB2 GENE FULL SEQUENCE $ 123.00 $ 156.64 $ 140.19 $ -     Available to XIFIN Customers
81253 GJB2 GENE KNOWN FAM VARIANTS $ 123.00 $ 81.56 $ 73.00 $ -     Available to XIFIN Customers
81254 GJB6 GENE COM VARIANTS $ 123.00 $ 74.97 $ 67.10 $ -     Available to XIFIN Customers
81255 HEXA GENE $ 123.00 $ 93.90 $ 84.04 $ -     Available to XIFIN Customers
81256 HFE GENE $ 50.00 $ 70.20 $ 62.83 $ 70.20     Available to XIFIN Customers
81257 HBA1/HBA2 GENE $ 235.00 $ 183.22 $ 163.98 $ 183.22     Available to XIFIN Customers
81260 IKBKAP GENE $ 140.00 $ 93.90 $ -     Available to XIFIN Customers
81261 IGH GENE REARRANGE AMP METH $ 305.00 $ 148.12 $ 132.57 $ 148.12     Available to XIFIN Customers
81262 IGH GENE REARRANG DIR PROBE $ 123.00 $ 51.12 $ 45.75 $ 51.12     Available to XIFIN Customers
81263 IGH VARI REGIONAL MUTATION $ 123.00 $ 259.93 $ 232.64 $ 259.93     Available to XIFIN Customers
81264 IGK REARRANGEABN CLONAL POP $ 123.00 $ 111.98 $ 100.22 $ 111.98    
Related searches:
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