Advocacy Update

• Urge Congress to Fix Medicare Now
• Advocacy Win: Arizona Pathologists and CAP Amend Forensic Autopsy Legislation
• Proposed Bill Would Alter Medical Examiner Findings in Washington State
• The CAP Advocates to Reverse CAR-T Payment Policy
• CDC Issues Ebola Health Alert
• Register for HOD/PLS 2025
• Preparing for the LDT Rule

Pathologists will be calling on lawmakers to enact the Medicare Patient Access and Practice Stabilization Act and reverse the Medicare cuts that went into effect on January 1.

The CAP strongly opposes the ongoing Medicare cuts to physician reimbursement and is actively working with lawmakers and partners to enact short- and long-term payment reforms. The CAP recently signed on to the American Medical Associations (AMA) letter urging Congress to include provisions that both reverse the latest round of Medicare payment cuts and provide physicians with a meaningful payment increase by a government funding deadline March 14.

The CAP is also using its grassroots network in support of this week's AMA National Advocacy Conference in Washington, DC. CAP members will receive an action alert on Wednesday, February 12, to message their congressional representatives to stop the cuts.

Legislation on duties of medical examiners in Arizona was successfully amended by the CAP in partnership with the Arizona Society of Pathologists (ASP), the Arizona Medical Association (ArMA), and the National Association of Medical Examiners (NAME) on January 22. The amendment to House Bill 2065 retains proper physician supervision requirements for forensic autopsies.

Under current Arizona law, Arizona medical examiner offices are having difficulty utilizing board eligible forensic pathologists for the direct supervision of medical students, residents, and fellows in pathology training during the performance of forensic autopsies.

The original legislation proposed to remove board-certified forensic pathologist supervision requirements to permit any licensed physician to oversee forensic autopsies when performed by medical students, residents, and fellows in pathology training.

The CAP worked closely with medical examiner offices to amend the legislation to ensure that licensed physicians trained in forensic pathology could oversee forensic autopsies and rectify staffing issues for such autopsies.

The CAP will continue to monitor the bill as it advances.

The CAP is opposing legislation in Washington State that would allow family members of any decedent whose case was classified as an opioid overdose, to request and compel a medical examiner finding to reclassify the death as a homicide when a related conviction of a homicide has occurred.

On January 27, the CAP, in conjunction with the Washington State Society of Pathologists (WSSP), sent a letter in opposition to House Bill 1478. CAP President Donald Karcher, MD, FCAP, noted in the letter that the independent medical judgment of a physician, in determining manner and cause of death, cannot and should not be subject to override from family members. While the opioid and addiction crisis are significant public health threats that needlessly claim many lives and at great family distress and societal cost, this legislation does not ameliorate the problem, Dr. Karcher said. In addition to the CAP and WSSP, the bill is opposed by the National Association of Medical Examiners (NAME).

The CAP also noted that explicit public CAP policies and the American Medical Association (AMA) policies both affirm the independent authority of medical examiners and the paramount need to protect their medical judgment from undue influence in the reporting of postmortem assessments and medicolegal death investigations.

The CAP will update members as updates become available.

CAP Economic Affairs Committee members met with officials from the Centers for Medicare & Medicaid Services (CMS) to advocate for appropriate physician recognition and reimbursement for providing care and management to Chimeric Antigen Receptor T-cell (CAR-T) therapy patients on February 3. The CAP disagreed with the CMS' 2025 finalized policy to recognize CAR-T services as part of the drug product manufacturing process and to not pay individually for each CAR-T service through the Medicare Physician Fee Schedule.

The CMS had finalized a policy in its final 2025 physician fee schedule rule to bundle payment for harvesting and preparation of CAR-T cells into the drug code and to not pay individually for CPT codes 38225, 38226, and 38227 through the Medicare Physician Fee Schedule or Hospital Outpatient Prospective Payment System (OPPS).

The CAP led a multispecialty effort to create and value four new category I CPT codes for CAR-T therapy (CPT codes 38225, 38226, 38227, and 38228). Specifically, these codes recognize the harvesting of blood derived T lymphocytes, the preparation and preservation of these collected lymphocytes for transportation to a manufacturing facility, the subsequent receipt and preparation of the modified lymphocytes for infusion into the patient, and finally the administration of the modified lymphocytes to the patient.

The CAP explained that the CPT codes associated with CAR-T therapy represent separate and distinct processes. Each step is labor intensive and requires the expertise of physicians and professional oversight and monitoring. CAR-T patients are very sick and must be monitored for specific treatment related complications such as fainting, allergic reaction, seizures, and abnormal heart rate. By not reimbursing physicians separately for each of the CAR-T services, the CMS is failing to recognize the medical decision making and physician work associated with managing these complex and extremely sick patients. CPT codes 38225, 38226, 38227, and 38228 represent patient care and management. Providing life-saving emergency care in response to significant treatment specific complications should never be considered part of the drug manufacturing process.

CAR-T services should reasonably be expected to follow similar payment policies used for other gene and cell therapies. The CAP specifically modeled the CAR-T coding after gene therapy with the expectation that it would follow the same payment pathway. In a comment letter, CAP urged the CMS to reevaluate their payment policies related to CAR-T therapy and to make appropriate edits to ensure that the physician work is appropriately recognized and compensated.

The US Centers for Disease Control and Prevention (CDC) recently issued a Health Alert Network Health Advisory about a confirmed outbreak of Ebola disease in Uganda caused by the Sudan virus (species Orthoebolavirus sudanense).

Currently, no suspected, probable, or confirmed Ebola cases related to this outbreak have been reported in the United States or outside of Uganda. However, as a precaution and because there are other viral hemorrhagic fever outbreaks in East Africa, the CDC is sharing best practices for public health departments, public health and clinical laboratories, and healthcare workers in the United States to raise awareness about this outbreak.

Read the full report

The CAP House of Delegates/Pathologists Leadership Summit provides pathologists with a unique opportunity to meet with CAP leadership and advocate on Capitol Hill about what matters most—our specialty and our patients.

Join us April 26–29 at the CAP House of Delegates & Pathologists Leadership Summit 2025. Network with your colleagues, learn leadership skills, and champion causes that impact pathologists. Register today!

Registered already? Share with your colleagues on social media and encourage them to register today using #MagnifyingthePowerofPathologists.

The clock is ticking. On May 6, the FDA's Stage 1 regulation on laboratory-developed tests (LDTs) is set to take effect.

While the CAP strongly opposes this burdensome rule, we remain committed to supporting pathologists and laboratories with these potential changes.

As we continue efforts to stop the rule, the CAP is equipping pathologists and laboratories with the resources to prepare for this pivotal deadline. Visit us online to access resources and tools to prepare.