I'm willing to be proven wrong, but there seem to be some weird typos in the CMS Clinical Lab Fee Schedule published for 2025. It seems to include a few codes deleted by AMA, and to ignore revised AMA CPT text for other codes.
What It Was Like
The mopath codes have long included 81432 (breast cancer gene panel) and 81433 (add on dup del studies). And 81435 (Lynch syndrome gene panel) and 81436 (add on dup del studies.)
What Happened
AMA heavily revised these gene panel codes, 81432 and 81435. At the same time, AMA deleted the dup del codes (deleted 81433 81436).
There was debate at CMS about how to price the new 81432 and 81435, but CMS settled on $1303, a PLA price used for a gene panel at Ambry (0129U).
What It's Like Now
Look up the CMS 2025 Excel spreadsheet, the standard reference for CMS's Clinical Laboratory Fee Schedule. (Links below.)
81432 is there, with the correct new price $1303. But the text shown is the old 2024 text. And 81433 is still there, even though it's been deleted by AMA CPT (book, page 669).
Similarly, 81435 is there, with the correct new price $1303. But the text is the old 2024 text. And 81436 (deleted dup del code) is still there at CMS.
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What's Next?
CMS has just released Transmittal 13966, March 13, effective April 1, making these corrections.
https://www.cms.gov/files/document/r13104cp.pdf
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CMS 2025 spreadsheet
CMS new priceshttps://www.cms.gov/files/document/r12992cp.pdf
81432 (AMA 2025 book)
Hereditary breast cancer related disorders (eg hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants.
Do not report with 81435, 81437
81433 has been deleted.
To report dup/del only, 81479.
81435 (AMA 2025 code book)
Hereditary colon cancer related disorders (eg Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familiar adenopolyposis), genomic sequence analysis panel, 5 or more genes, interrogation for sequence variants and copy number variants
Do not report with 81432, 81437.
81436 has been deleted.
To report dup/del only, 81479.
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