Optimizing RCM with 2024 CPT Code Updates

7 Key Takeaways:

Pricing for Myeloid assays remains unchanged
All GSP codes are now structured by variant type and nucleic acid (DNA versus RNA)
There are gaps in the GSP structure, as not every combination of variant type and nucleic acid exist
As there are previous GSP codes structured by gene count and now new GSP codes that do not contain gene requirements, there is key differences in the structure between the first 6 codes and the new 6 codes (though they have all been updated to include variant types)
The new GSP codes were gapfilled by MAC in 2024 and are now preliminarily priced by CMS for the CLFS in 2025
Payers are now reviewing each new GSP code for their medical policies
cfDNA now have their own codes and descriptions separate from solid tumor codes

Sarah Overton,

Director, Revenue Cycle Management

Sarah has over 20 years of healthcare industry experience working for multiple Fortune 500 companies including Cardinal Health and Novartis. Most recently Sarah has over 15 years in NGS, with a focus on oncology diagnostics and specializing in revenue cycle management including billing, collections, market access and reimbursement. Sarah has led multiple RCM teams at laboratories including Genoptix, Adaptive Biotechnologies, Cooper Genomics and Velsera. Currently at Velsera, Sarah is the Director of Revenue Cycle Management and addresses client reimbursement needs and concerns, leading the revenue cycle management team and overseeing Velsera’s RCM Services offering with a focus on MolDX and Technical Assessments and maximizing laboratory revenue.