Discoveries in Health Policy

Quick Access to Top Providers of any "Popular" Part B CPT Code. OpenMedicare.US

2026-04-01T10:56:00.000-07:00

CMS group "Data.CMS.Gov" has an elaborate website for payments to providers by CPT code. It's a little tricky to use but powerful. Find it here:https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-serviceThere's a nonprofit website OpenMedicare.US, that lets you look up the

AMA CPT Publishes Latest Batch of Quarterly PLA Codes

2026-04-01T10:44:00.000-07:00

On April 1, 2027, AMA CPT released the results on the latest batch of quarterly PLA codes. These codes were applied for around December 10, published today, and active July 1AMA summarizes there were 2 revisions, 4 deletions, and 29 new codes 0631-659U.https://www.ama-assn.org/system/files/cpt-pla-codes-long.pdfNote that AMA includes a number of important instructions for acceptable

Will CMS Nationalize MOLDX? Coverage at 360DX

2026-04-01T10:26:00.000-07:00

A month ago, CMS announced a major new anti-fraud initiative, called CRUSH. It had two main targets: DME fraud and genomics fraud. The comment period closed on March 30, and journalists are sorting through the comments received.See coverage by Adam Bonislawski here (subscription). (See my CMS comment here).I see a Regulations.gov posting that 768 comments were

New to Me: AMA Comment Deadlines are NOON CENTRAL on the Day

2026-03-31T10:41:00.000-07:00

New to me, so I'm just flagging this.The last few weeks, comments have been accepted for the April 30 - May 1 AMA CPT meeting. One important topic is revisions to Appendix S, a major ongoing issue that affects AMA CPT policy for software-intensive services (e.g. AI).The comment deadline is March 31 2026, I had that right.I for one, had not noticed the specific deadline is 11:59 am

Horizons in Diagnostics Value: Case Study: Rethinking Value for Infection Diagnostics

2026-03-30T11:17:00.000-07:00

Here's a paper that is worth discussion, and potentially applicable to many areas of diagnostics, not just infection.In a 2025 paper at Open Forum Infectious Diseases, some excellent thought capital is created by Claeys, Prinzi, and Timbrook. Here.It's also a great example of a good abstract - I can't do better than quoting it.Evaluating the clinical impact of in vitro diagnostic tests (

Chris Klomp, Health Policy Expert for CMS and HHS - Some Notes on His Experience

2026-03-28T09:56:00.000-07:00

Over the last few weeks, shake-ups at HHS have brought Chris Klomp to the #2 position next to Secretary Kennedy. See news reports here; see an annotated one-hour interview with Klomp here.I asked Chat GPT to discuss his educational background and professional experience through the lens of his current top-level health policy roles.Endpoints discusses Klomp on AI, Klomp on biotech/China,

Korie et al. 2026: What Drives Next Gen Sequencing Denials at Yale Pathology?

2026-03-27T11:15:00.000-07:00

Header: A Yale pathology study presented at USCAP 2026 shows that NGS reimbursement denials are less about overuse and more about administrative failure—especially ICD-10 miscoding. Only 20% of cases were denied (275/1392), and most denials occurred despite guideline-concordant testing. The authors conclude, the fix is operational, not clinical.Reimbursement Denials for NGS: A Systems

Register for AMA Meeting on Coding & AI: "Appendix S Revisions" - April 16

2026-03-27T09:49:00.000-07:00

AMA has big, big plans for changing how it handles AI services (potentially affecting digital pathology and genomics) in terms of policy and coding, possibly even with whole new classes of codes. These come under the headline of "Revising Appendix S," which has been a topic for several AMA CPT meetings in a row. You can register with AMA to view and comment on

AI, Advanced Software, and AMA CPT Policy: Deadline March 31: Appendix S for Upcoming CPT Meeting

2026-03-26T10:04:00.000-07:00

For several quarters, AMA CPT has been debating major amendments to the AMA CPT "Appendix S," which may have enormous implications for how AI- or software-dominant healthcare services are reimbursed.At the upcoming AMA CPT meeting in Chicago [virtual registration still available], a new round of revisions to Appendix S will be debated. You can sign up now to read the current revisions

Comment on CRUSH, CMS Policy, Genomic Testing: Due Monday, March 30

2026-03-26T09:42:00.000-07:00

On February 27, 2026, CMS announced a vigorous plan for anti-waste, anti-fraud measures in Medicare, with strong highlighting given to two areas: (1) durable medical equipment DME, and (2) genomic testing. The initiative, abbreviated CRUSH ("crush fraud") is open for public comment until Monday, March 30, 2026.See my blog and links here:https://www.discoveriesinhealthpolicy.com/2026/

Nerd Note: 2017 PAMA Raw Data File is Still Posted

2026-03-24T10:03:00.000-07:00

Header: CMS still stores publicly available cloud data on lab test pricing surveyed in 2017 and representing CY2016.### Congress and CMS are re-activating the PAMA reporting process. For reporting laboratories who had >$12500 in Medicare payments in 1H 2025, they will report data on all claims paid by commercial payors in 1H2025, and they will report in May-June-July 2025.&

AI Experiment: How Alex Dickinson Describes the CARIS MCED ACHEIVE Report

2026-03-23T09:42:00.000-07:00

In March, Caris released top-line results of its ACHIEVE study, testing its MCED test in real cases. Press release here. Active Linked In author Alex Dickinson wrote a set of 5 articles about the results. One, two, three, four, five.Out of curiousity, I asked what Chat GPT could make out of the six documents.AI CORNER###OverviewCaris reports striking interim performance for its

CMS Reports on First Rural Health Summit under Tech Transformation

2026-03-23T09:27:00.000-07:00

One of the lesser-known outcomes of last summer's budget bill was $50B for rural health transformation (RHT) focused on technology. Last fall CMS established the Office of RHT and in December $50B of awards were announced. Home page here.On March 18, CMS convened leaders from all 50 states to discuss. Find the online report here:https://www.cms.gov/newsroom/press-releases/

Journal Club: Value of WGS in Real-World Cancers (Van Putten, Nat Med)

2026-03-21T16:15:00.000-07:00

What's the value of going upscale to whole genome sequencing (WGS) in solid cancers? Van Putten et al. assemble date from their experience with 888 solid cancers. The work is from Hartwig Medical Foundation / Netherlands Cancer Institute.Find the paper here and a Linked In essay here by Joseph Steward. And here by Alex Dickinson. Dr. Cuppen here, scientific director

Can AI Re-Think Health Policy? Example Using WSJ Policy Essay (& MolDx)

2026-03-20T11:29:00.000-07:00

Can AI read an article and project its possible applications into a different field? That's today's question. Starting point: WSJ runs an essay by Harvard economics professor and Manhattan Institute authority Roland Fryer. Fryer here, essay here. While his article was on "regulating AI," it clearly had ramifications or applications in other policy domains. I

NCCN Recommends NGS in All Stages of Pancreatic Cancer: Direct Conflict with Outdated Medicare NCD

2026-03-19T14:54:00.000-07:00

Tuesday, I was in a webinar where stakeholders were discussing the badly-outdated Medicare NCD for NGS testing in cancer. Thursday of the same week, more proof of the problem hit my inbox.See the March 18, 2026, release of new pancreatic cancer management guidelines from the National Cancer Center Network - NCCN. Here. See coverage in Genomeweb, here.

Waiv (Former Owkin Dx) Brings In $33M For AI Precision Diagnostics

2026-03-17T14:52:00.000-07:00

It's not every day you hear of a new $33M going into spatial diagnostics - but it happened this week.WAIV Diagnostics, Paris (former Owkin Dx) is now a spinout from Owkin and pulling in its own investors and funding. https://wearewaiv.com/news/waiv-secures-33-million-to-scale-ai-precision-testingSee also a post from Meriem Sefta, WAIV CEO.https://www.linkedin.com/posts/

Illumina Publishes "Diagnostics Year in Review" CY2025 (48pp)

2026-03-17T14:48:00.000-07:00

Once again Illumina has published its Diagnostics Year in Review. See CY2025 in a birdseye view, edited by Mara Aspinall, 48pp.https://www.illuminaventures.com/wp-content/uploads/2026/02/Diagnostics-Year-in-Review-2025-Version-for-Distribution.pdf##AI CORNER##TL;DR ? Should you read this 48-page “Diagnostics Year in Review”?Yes—if you care about where genomics, AI diagnostics,

BLOODPAC Releases Webinar and White Paper: New Frontiers in Therapy Selection / Beyond DNA Mutations

2026-03-17T11:20:00.000-07:00

BLOODPAC offered a multi speaker seminar last fall on the topic, New Frontiers in Therapy Selection: Beyond DNA Mutations. Find the online resources now.Here's the home page: link.Find the two-hour YouTube webinar here: https://www.youtube.com/watch?v=yuYdhbdVcpUAs you scroll the home page, you'll also reach the 37 page white paper.###AI CORNER###Chat GPT 5.4 reads and summarizes.###

Chris Klomp Now Near Top of HHS; See His One-Hour Recent Interview

2026-03-14T11:02:00.000-07:00

Wall Street Journal, Politico, Washington Post have all been covering the shake-up in senior management at HHS - here. Chris Klomp rises to #2 at HHS. Here's a profile of Klomp from several news articles. Here's an interview with Klomp on China & Biotech.Which gives extra importance to a one-hour interview that Paragon Institute posted just a few weeks ago.

The Strange Place of FIT Testing Between FDA Label and Medicare Screening

2026-03-14T08:18:00.000-07:00

Header: CMS is reviewing its coverage standards for CRC screening biomarkers - stool, blood, etc. But CMS explicitly will ignore fitting FIT testing into the new system. (FIT testing will remain untouched and as-is.)There's quite a story there - FIT testing is FDA-regulated much differently than Cologuard, Shield, etc. Here's an essay planned by me,

WSJ: White House Shakes Up HHS Management

2026-03-14T07:10:00.000-07:00

Per the WSJ March 13 and 14, White House has multiple pathways for "shaking up HHS" at the top management level.https://www.wsj.com/politics/policy/white-house-pushes-shake-up-at-hhs-ahead-of-midterms-6ad882a5 and also https://www.wsj.com/politics/policy/trump-rfk-jr-hhs-midterm-elections-cef51179See also WaPo and Politico.Chris Klomp, NovemberWhite House

Mapping the Colorectal Cancer Screening Proposal: Why Use an Efficiency Frontier

2026-03-13T09:24:00.000-07:00

CMS has a current NCD for biomarker CRC screening, using 74% sensitivity and 90% specificity as a benchmark. This means you pick up about 3/4 of cancers (relative to colonoscopy) and you send about 10 patients per 100 to a false positive based colonoscopy.Here I expand on a prior blog and show the two new CMS options graphically.We can show the statistical space on a probability chart.

AI History You Can Use: MACs, BCBS Plans, Corporate Structures in Review

2026-03-13T07:00:00.000-07:00

There are many complex relationships among Medicare contractors, Blues plans, holding entities, novelty names (Elevance), and more. Chat GPT works hard to sort it all out.I've read it all and it's directionally correct and consistent with what I know - but don't guarantee every word is correct. It's a for-example of what AI research and AI writing can create, as of 3/2026.###The

AI History You Can Use: Relive Amazing 2007-2010 Debates about FDA, LDT, CDX

2026-03-12T13:21:00.000-07:00

In the past couple years, we've lived through FDA regulation of LDTs, court cases, and expanding capabilities of genomic diagnostics, many of them LDTs. However, it's worth while to recall a period 2007-2010, when a PGx test to predict rituximab responders led to pushback from Genentech against LDTs, a Citizen's Petition to FDA, and a National Academies review in 2010. The PGX FCGR