A Preliminary Review of Adoption of New HCPCS codes for NGS in CMS Claims

Highlights:

• While adequate reimbursement is considered a prerequisite for adoption of new diagnostic technologies detailed longitudinal investigation of the adoption of new HCPCS codes and the factors influencing it are scarce.
• Diaceutics examined the claims for each of the three CPT codes used for next generation sequencing in a large database of claims data from CMS and attempted to correlate presumptive drivers of test adoption.
• This study demonstrates that determination of factors affecting adoption of a test technology can be problematic due to a wide variation in claims over a relatively short space of time. However, determination of these factors is important as they ultimately affect patient access to testing and potentially to therapy.