With the introduction of new CPT codes, laboratories will soon be one big step closer to seeing added reimbursement for the value they deliver with digital pathology.
Last week, the American Medical Association (AMA) published 13 new add-on CPT digital pathology codes. The College of American Pathologists (CAP), which worked closely with the AMA to advocate for the inclusion of these codes, first shared the news. As the CAP explains, the new Category III codes will be “used to report additional clinical staff work and service requirements associated with digitizing glass microscope slides for primary diagnosis.” They go into effect on January 1, 2023.
The creation of new CPT codes – even Category III codes for which there is not yet additional compensation – doesn’t happen every day. I view this development with extraordinary enthusiasm, and here’s why you should, too.
Paving the way for added reimbursement
Today, laboratories in the US report on all diagnostic reads using the same CPT codes, regardless of whether that read was made under the microscope or using a digital pathology system. This means that payors have not distinguished the use of digital pathology when it comes to reimbursement because they are unable to do so.
This is changing. By enabling laboratories to specifically report when they’ve made a diagnosis using digital pathology, the new CPT codes will provide payors with the data they need to directly understand the utilization of digital pathology and its impact. In turn, laboratories will be one big step closer to seeing additional reimbursement for digital reads. Payors will finally be equipped to independently assess the increased value, and this is exciting.
Unleashing the next wave of adoption
Let’s jump to another big step forward – this one for the industry.
The adoption of digital pathology has already been accelerating in the US even without additional compensation as other barriers have been broken down; cloud storage has become much more affordable, scanners have higher throughput, the experience of digital pathology platforms has improved, and FDA approvals have been granted.
Now, the new CPT codes are working to chip away at one of the final blockers that remain: reimbursement. Consider that in many European countries, where there have been payment structures or reimbursement pathways specifically for digital pathology in place for years, adoption is nearing 100%. It’s easy to see why the new codes could help to unleash a new surge in demand here in the US.
A big congratulations to the CAP and the AMA on this significant industry milestone. It’s an exciting time for digital pathology, and I look forward to all that’s ahead.
