H.R. 2557 — what changed

changed “(Q) in the case of a DNA Specimen Provenance Assay clinical diagnostic laboratory test (DSPA test), test) furnished on or after the date specified in section 1834A(j)(4), unless the DSPA test is furnished to an individual enrolled under part B who has had a prostate cancer biopsy the results of which are positive, the DSPA test is furnished with respect to such biopsy, and the DSPA test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested;”

“(j) DNA Specimen Provenance Assay clinical diagnostic laboratory tests

changed “(1) Temporary payment amount for certain tests furnished during 2018 through 2020—Notwithstanding the payment amount that would otherwise apply under this section, with before 2028—With respect to a DNA Specimen Provenance Assay clinical diagnostic laboratory test furnished on or after January 1, 2018, the date specified in paragraph (4) and before January 1, 2021, 2028, the payment amount under this section for such test shall be equal to 85 percent of the amount determined under the fee schedule under section 1833(h)(1) for 2016 for HCPCS code 81265.$200.

changed “(2) HCPCS code assignment—The Secretary shall assign an HCPCS code to the DNA Specimen Provenance Assay clinical diagnostic laboratory test.and modifier assignment

changed “(3) Ensuring proper billing “(A) In general—The Secretary shall assign one or more HCPCS codes to the DNA Specimen Provenance Assay clinical diagnostic laboratory test and paymentmay use a modifier to facilitate making payment under this section with respect to such test.

changed “(A) Use “(B) Identification of modifier to ensure proper payment—The DNA match on claim—The Secretary may use shall require an indication on a modifier to facilitate making payment under this section with respect to claim for a DNA Specimen Provenance Assay clinical diagnostic laboratory test.test of whether the DNA of the prostate biopsy specimen for such test matches the DNA of the individual with respect to whom the test was ordered. Such indication may be made through use of a HCPCS code, a modifier, or other means, as determined appropriate by the Secretary.

changed “(B) Paid claims sample error rate“(3) DNA match review

changed “(i) “(A) In general—The Secretary shall conduct a post-payment review of a sample at least three years of not less than 50 claims under part B for DNA Specimen Provenance Assay clinical diagnostic laboratory tests to identify whether the DNA of the prostate biopsy specimens for which payment is made under this part. The sample reviewed under such tests matched the preceding sentence may be taken from claims paid DNA of the individuals with respect to more than one supplier.whom such tests were ordered.

changed “(ii) “(B) Posting on Internet website—Not later than July 1, 2019, 2024, the Secretary shall post on the Internet website of the Centers for Medicare & Medicaid Services the number findings of claims with errors identified based on the reviews review conducted under clause (i).”subparagraph (A).

added “(4) Date specified—For purposes of paragraph (1) and section 1862(a)(1)(Q), the date specified in this paragraph is the first day of the second calendar quarter that begins at least 180 days after the date of the enactment of this subsection.”