Discoveries in Health Policy

Humor: AI News Article About My Appendix S Blog

2026-06-27T15:38:42.513-07:00

Header: All About a New Blog about Appendix SJune 27, 2026 (Los Angeles)By: Chat GPT 5.5In a new post at Discoveries in Health Policy, medical innovation and reimbursement expert Bruce Quinn uses an unusual but effective format: he asks two advanced AI systems to analyze the AMA’s revised 2027 CPT Appendix S, then compares their conclusions. The result is a layered review of one of the more

Appendix S from A to Z. Two AI's Review New Appendix S for 2027

2026-06-27T15:13:47.653-07:00

Two AI's Review the AMA's New Artificial Intelligence Coding Rules "Appendix S 2027"As of June 27, I believe the 2027 version is here:https://www.ama-assn.org/practice-management/cpt/cpt-appendix-s-taxonomy-artificial-intelligence-medical-services-proceduresAnd the 2025-and-earlier version still online here;https://www.ama-assn.org/system/files/cpt-appendix-s.pdf###CHAT GPT 5.5 followed by

AMA CPT: Coding Policy EARLY RELEASES: Cat I, Cat III, PLA, APP S AI, ADMIN MAAA

2026-06-27T14:47:03.955-07:00

AMA has released a website that displays "early release" updates in policy in five areas:Category I CodesCategory III CodesPLA CodesAppendix S: The "AI Taxonomy"Administrative MAAA codesFind them all here:https://www.ama-assn.org/practice-management/cptEarly ReleaseThe Category I, Category III, PLA, and administrative MAAA code sets all include some form of early-release codes. Category III

Guest AI Blog: Radiology is Starting to Write Reports. Pathology Should Pay Attention.

2026-06-27T11:00:06.493-07:00

Radiology AI Is Starting to Write Reports. Pathology Should Pay Attention. [Claud Opus 4.8]Radiology AI is crossing the line from flagging findings to drafting the report. STAT's recent coverage of Cognita, Aidoc, RSNA 2025, and two new FDA breakthrough designations is, for digital pathology, a preview of the next three years — including the awkward part nobody markets: a draft report

Pathology Codes for September 2026 Minneapolis Meeting

2026-06-26T11:36:54.373-07:00

The next AMA CPT meeting is in Minneapolis, September 17-19, 2026.The registration isn't open yet, but will be found here:https://www.ama-assn.org/membership/events/cpt-editorial-panel-meetingLab tests follow an early comment cycle, from now June 26 to July 13.Note that comments are due noon central, ten pacific, on July 13.(Regular, non-lab code list to be released July 10).See the lab code

Very Brief Blog: Price Analysis of Wild 2017 PAMA Data

2026-06-26T11:01:20.828-07:00

We're gearing up for PAMA cycle II, CMS will release millions of lines of data in August or September 2026, in preparation for the new CLFS fee schedule in 2027.Here's a look back at some of the wild data results in 2017.https://www.discoveriesinhealthpolicy.com/2017/09/pama-raw-data-provides-unprecedented.htmlHere's one panel from the 2017 blog.Eg BRCA pricing ran from $1000 to $3220 (

The Wide Dispersal of Payment Rates for...Anatomic Pathology

2026-06-26T10:25:32.413-07:00

From time to time, there are articles about the wide dispersal of prices in US healthcare. (One patient and health plan pays $1000, another patient and health plan pays $6000). We saw that wide dispersal of pricing in the 2016 clin lab payment data released in mid 2017 by CMS as part of PAMA market rates for lab test pricing. By August 2026, we'll have a huge update of 1H2025

Digital Pathology Association/DPA Issues Two Linked Documents on AI Validation and Reimbursement

2026-06-26T09:40:24.127-07:00

Digital Pathology Association Issues Two Linked Documentson AI Validation and Reimbursement1. Recommendation Statement for the Validation, Implementation, and Clinical Application of Artificial Intelligence Within a Clinical Laboratory from the Digital Pathology Associationhttps://journals.sagepub.com/doi/10.1177/2993091X2614559752. Full Speed Ahead: Shaping the Future of Digital Pathology

The June 25 HHS Update on AI in Clinical Care: Meeting Summary

2026-06-25T13:50:17.381-07:00

In December 2025, HHS announced an RFI on how it could improve access to AI for clinical care. See webpage here, Fed Reg here. (90 FR 60108, 12/23/2025).On June 25, HHS held an hour-long webinar to update the public on progress. While the three arms of the program are regulation, research and development, and reimbursement, they opened by announcing this webinar would include

Very Brief Blog; Implementing Enhanced CLIA (HR 8890)

2026-06-25T11:48:46.619-07:00

Repr. Dr. Dunn of Florida has introduced CLIA enhancement legislation. Read the 45-page bill here, see a law firm introduction to it, f rom Covington, here.Over at LinkedIn, Dr Joe Lennerz provides a detailed and illustrated depiction of how the legislation might be implemented and how, and when, it would affect real-world laboratory tests in your lab.Find it here:https://

Gapfill-ology 2026: Variances in MAC Gapfill Proposals Summer 2026

2026-06-25T10:52:31.049-07:00

This year 18 codes are in the Gapfill process, with comments accepted to July 13, 2026.Find the spreadsheet at the CMS CLFS webpage, scrolling down to Gapfill proposals.https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs/annual-public-meetingsWhat's Up/There were only 2 codes of 18 where MolDx and Novitas prices aligned (0420U, 0569U). But there

The Mystery of Wellpoint Federal (aka NGS MAC) CAC Meetings

2026-06-24T12:44:00.112-07:00

Recently, Noridian announced that on August 20, 2026, there will be a Contractor Advisory Meeting on the topic of tests for neurodegeneration. it will be multi-contractor, including CGS, Noridian, Wellpoint Federal, and Palmetto. See an announcement at Noridian here, at CGS here.I didn't see Novitas as a co-sponsor and at least so far, nothing on their CAC calendar

Part 2: DOJ Treasure Trove of Health Fraud:Twelve Themes and Two Defenses

2026-06-24T03:03:01.538-07:00

Yesterday, I published a long blog taking a first look at a 'treasure trove' of over 300 DOJ case summaries and some 300 actual full length court documents. Yesterday I focused on the 300 case summaries.In today's blog, I downloaded the first 20 of the 300 full-length court documents (complaints, indictments), and asked Chat GPT 5.5 to take the role of a law school professor expert in

Part 1: DOJ Releases Little-Remarked Treasure Trove of Medical Fraud Data

2026-06-23T16:59:01.847-07:00

On June 23, 2026, you couldn't swing a cat without encountering news articles about a big HHS anti-fraud operation. Most of the first-day articles stuck close to a couple case studies and near-the-surface source material.NY Times:CNN:Today we'll take a first look at the data. Where is Medicare "hackable?"See also several Appendices at bottom.Tomorrow, we'll look at overall themes

AI Guest Column: Digital Pathology Association's 27-page Recommendation for AI SW Validation & Implementation

2026-06-23T14:40:39.585-07:00

[Chat GPT 5.5 Guest Author]##Digital Pathology AI Moves from “Cool Demo” to Clinical Infrastructure: The New DPA Recommendation StatementA new recommendation statement from the Digital Pathology Association arrives at exactly the right time.For several years, computational pathology has had the flavor of a rapidly advancing frontier: striking images, impressive AI heat maps, strong

Follow Up: CMS and Ancient Cobol Claims Processing; RFI for System Change

2026-06-23T11:39:00.981-07:00

A few weeks ago, I published a blog article on the status of "ancient" claims processing systems at CMS - here. By chance, I ran across a Q1 2026 Request for Information from CMS, discussing large-scale renewal of the creaky claims processing system. Find the RFI webpage here:https://sam.gov/workspace/contract/opp/521fdf2c4dac48e48e0dbd5eb83a8df6/viewWhere we

CMS Coverage History: How "CAC" Meetings Evolved (2004, 2015, 2019)

2026-06-22T13:53:20.682-07:00

Medicare's contractor advisory committees have evolved greatly from 2005, to 2015, to the present (2019 forward). I've put the Medicare LCD Manual from each period into one cloud zip file (here).I asked Claude Opus to evaluate those three files, and compare CAC meetings under each era.Afterward, I ask Chat GPT to put the CAC evolution 2004-2019-today, into a broader perspective

Slow LCDs: Some Date Snapshots

2026-06-21T21:30:13.602-07:00

We often hear about slow timeliness for LCDs, and outsiders can't always believe the numbers. ("We can turn in your LCD request by August 1, 2026; contemporary data shows the LCD may be finaled as late as in August, 2032.") A bill for quicker LCDs, H.R.8500, has been proposed.Case StudyMolDx received a dossier and coverage request for DCIS breast cancer molecular testing in June

OIG: Another Workplan, This Time It's Genetic Tests in Part B

2026-06-18T13:33:28.529-07:00

A few days ago we flagged an OIG workplan about pathogen panel coding for > 5 pathogens (think 87798) - here.OIG has another another molecular pathology workplan - this one focused on genetic tests.The audit and report is expected to run 2026-2028. In particular, they will look for differences in payments between MOLDX and Non-MOLDX geographies.https://oig.hhs.gov/reports/work-plan

AI Corner: Chat GPT Interprets German-Language Sequencing Policy Documents

2026-06-18T12:37:12.904-07:00

This week, Genomeweb has an excellent article about reimbursement and policy changes in German regarding NGS. The article includes a number of important commentaries from experts. As an AI experiment, I was curious how well Chat GPT could read the underlying 8-page and 35-page dense government documents in German, and turn them into an article for English-speaking US readers.&

CMS Puts HCPCS Modifiers for Local, Metastatic Cancer - On Hold

2026-06-18T11:53:23.639-07:00

Last fall, CMS proposed to create two cancer modifiers as two-letter HCPCS codes, for local versus metastatic cancer. (See my February blog here).CMS has published its final results based on that December 2025 code cycle, and CMS will NOT procede with the cancer modifiers at this time.Find the "Final Decisions" PDF here, and see page 144 "Next Generation Sequencing."#### (1)https://

Vinay Prasad: HE'S BACK

2026-06-17T21:33:22.975-07:00

Before Vinay Prasad, the UCSF oncologist, served as head of CBER at FDA, he was famously outspoken—in blogs, vlogs, podcasts, and peer-reviewed articles.During his time at FDA, those informal channels went quiet. Now that he is out of FDA, he appears to be back at full volume. His YouTube channel, dormant for a year, has posted nine new vlogs in a month, most running 20 to 30 minutes.https:/

Register Now for June 25 HHS Webinar on AI, Policy, and Reimbursement

2026-06-17T20:33:33.612-07:00

HHS Webinar June 25: What Did HHS Hear About AI in Clinical Care?##AI Corner: Chat GPT 5.5##In December 2025, HHS issued a broad Request for Information asking how the Department should accelerate the adoption and use of artificial intelligence in clinical care. The RFI was only 3 pages, but it was pointed. HHS asked how it should use three big levers — regulation, reimbursement, and research and

Very Brief Blog: Using AI to FInd Someone's Name

2026-06-17T20:14:51.130-07:00

We live at a time where some people use AI like second nature and some nearly never.Here's a real life example. For a moment today I was blocking on the name of Jennifer Leib, a well-known health policy consultant in DC. Here's my prompt and here's the result.###PROMPTThere is a woman in washington dc whose training is as a genetic counselor and she runs a small but high quality

Breaking News: Noridian to Hold Meeting on Neurodegenerative Diagnostic Lab Tests

2026-06-16T13:56:20.119-07:00

There's been a boom in more accurate lab tests in neurodegenerative disease - both Alzheimer's and Parkinson's - and quite a few CPT codes in this space. But it's been "crickets" in terms of Medicare coverage policies.Details are pending, but the Noridian MAC plans an advisor workshop (a "CAC") on the topic on August 20, 2026. Potentially that could precede an LCD a few