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

Wed Jul 06 2022

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

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

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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.


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

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