@Hawk70, @danhoff - I emailed IR about this, but online it seems that the crosswalk rate applies:
Example 1: Crosswalking for Similar TestsA new diagnostic test, Test A, is introduced to detect a specific biomarker for a disease. CMS determines that Test A is clinically and operationally similar to an existing test, Test B, which also detects biomarkers of comparable complexity and clinical use.Test B has an established CPT code with a reimbursement rate of $150.CMS assigns Test A to the same CPT code through crosswalking, meaning Test A will also be reimbursed at $150.This approach simplifies reimbursement and aligns rates for tests of similar utility.
Example 2: Crosswalking with Minimal AdjustmentsA new molecular diagnostic test, Test X, identifies genetic mutations linked to a rare condition. CMS finds it similar to Test Y, which identifies genetic mutations for another condition. While Test X involves slightly different reagents, the clinical application and resource requirements align with Test Y.Test Y has a reimbursement rate of $200.CMS crosswalks Test X to Test Y’s code and reimbursement rate.The decision is based on the comparable clinical and laboratory requirements.
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