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Last Modified: 3/5/2021 Location: FL, PR, USVI Business: Part A, Part B

2021 gap-fill survey

Note: Due to low volume of responses received thus far, we are extending the due date for completing the survey. If you have not already done so, please complete our survey at external link by March 29. Please complete a separate survey for each test you perform.
First Coast the MAC for jurisdiction N (JN) is in receipt of the new laboratory test codes identified by CMS to be gap-fill priced for 2021. The Protecting Access to Medicare Act (PAMA) regulations instruct the MACs to establish local payment amounts for the new laboratory test codes using the following sources of information, if available:
1. Charges for the test and routine discounts to charges
1. Resources required to perform the test
2. Payment amounts determined by other payors
3. Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant
First Coast seeks your input on establishing pricing under the Medicare program for new laboratory test codes 86328, 86769, 87635, 0101U, 0102U, 0103U, 0129U, 0139U, 0140U, 0141U, 0142U, 0143U, 0144U, 0151U, 0152U, 0153U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0163U, 0164U, 0165U, 0171U, 0173U, 0174U, 0175U, 0178U, 0179U, 0180U, 0206U, 0207U, 0208U, 0209U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0219U, 0220U, 0221U, 0222U, 0015M, 0016M, U0001, U0002, U0003, and U0004. To that end, First Coast kindly requests that you complete our survey at external link by March 29.
Please note that your answers will be kept to the greatest degree of confidentiality and will not be disclosed, except as may be necessary to share with others under confidentiality agreements with CMS for the sole purpose of establishing Medicare clinical laboratory fee schedule gap filling pricing.
Your responses will be reviewed and evaluated by First Coast and if proper, set forth in its recommendations to CMS of the appropriate fees for these tests. If no response is received, the fee will be determined by evaluating the charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant.
Note: The presence of an established local payment amount does not imply coverage.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.