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Diagnostics: Payment Rates

CMS Releases 2019 Preliminary CLFS Payment Determinations

September 21, 2018

CMS releases CY 2019 preliminary recommendations for codes reviewed during summer the 2018 Lab Public Meeting.

The Latest from our Diagnostics Resource Center

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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

Diagnostics: OIG

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

September 20, 2018

OIG releases the fourth in a series of data briefs looking at Medicare spending under the Clinical Laboratory Fee Schedule.

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CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

Insight: original analysis

CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

July 26, 2018

Beginning January 1, 2020, when submitting claims to Medicare for advanced diagnostic imaging services furnishing professionals and entities must certify that professionals ordering services consulted AUC applicable to the imaging modality

ORIGINAL ANALYSIS

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Diagnostics: Date of Service

Laboratory Test Codes Subject to Date of Service Exception (Updated 6/25/18)

July 19, 2018

EXTERNAL LINK

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CMS Announces Period of Enforcement Discretion on Date of Service Rule

Diagnostics: Date of Service , Original Analysis

CMS Announces Period of Enforcement Discretion on Date of Service Rule

July 09, 2018

EXTERNAL LINK

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Diagnostics: Payment Rates

CMS Posts Preliminary Gapfill Pricing Determinations

June 21, 2018

CMS Posts Preliminary Gapfill Pricing Determinations

EXTERNAL LINK

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Diagnostics: Regulation

Frequently Asked Questions, CMS 1621 F, Medicare Program

May 14, 2018

Frequently Asked Questions, CMS 1621 F, Medicare Program – Medicare Clinical Diagnostic Laboratory Tests Payment System, Final Rule.

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Diagnostics: Guidance

CMS releases April CLFS pricing file

April 05, 2018

EXTERNAL LINK

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Diagnostics: Payment Rates

CMS releases list of lab codes for review at Annual CLFS Public Meeting

April 02, 2018

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CMS announces meeting of Advisory Panel on Clinical Diagnostic Tests

Diagnostics: Payment Rates

CMS announces meeting of Advisory Panel on Clinical Diagnostic Tests

March 29, 2018

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CMS announces Annual CLFS Public Meeting, June 25, 2018

Diagnostics: Payment Rates

CMS announces Annual CLFS Public Meeting, June 25, 2018

March 29, 2018

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Diagnostics: PAMA

Guidance for Laboratories on ADLTs

March 23, 2018

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CMS releases application for ADLT status

Diagnostics: PAMA

CMS releases application for ADLT status

March 23, 2018

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Insight: original analysis

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

December 12, 2017

ORIGINAL ANALYSIS

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Diagnostics: Litigation

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

December 12, 2017

On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

ORIGINAL ANALYSIS

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Diagnostics: Payment Rates

CMS Releases Final CY 2018 CLFS Payment Rates

November 22, 2017

Zip file available for download.

EXTERNAL LINK

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Diagnostics: Guidance

CMS Releases Final CY 2018 Crosswalk and Gapfill Determinations

November 22, 2017

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Diagnostics: PAMA

Unlisted procedure code data collection

November 01, 2017

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Diagnostics: Guidance

CMS instructs contractors to stop applying Automated Test Panel edits to claims effective January 1, 2018

October 20, 2017

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Diagnostics: Guidance

CMS Instruction to Contractors to Report Claims Data for “Not-OtherwiseClassified” Lab Codes

October 13, 2017

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Diagnostics: Guidance

OIG releases report on Medicare payments for Lab Tests

October 04, 2017

EXTERNAL LINK

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Diagnostics: Payment Rates

CMS releases Panel recommendations from September 25, 2017 meeting

September 29, 2017

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Diagnostics: Payment Rates

CMS Releases Preliminary PAMA Based Payment Rates

September 22, 2017

EXTERNAL LINK

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Diagnostics: Payment Rates , Regulation

CMS Releases Agenda for September 25 virtual meeting of Advisory Panel.

September 20, 2017

CMS Releases Agenda for September 25 virtual meeting of Advisory Panel.

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Diagnostics: Payment Rates

CMS Announces Virtual Meeting of CDLT Advisory Panel

September 13, 2017

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Diagnostics: Guidance

CMS solicitation of comments on 60 codes without reported data

August 08, 2017

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Diagnostics: Payment Rates

CLFS Public Meeting

June 15, 2017

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Diagnostics: Payment Rates

CDLT Advisory Panel Meeting

June 15, 2017

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Diagnostics: PAMA

CMS Announces Enforcement Discretion for PAMA Reporting Requirements

March 30, 2017

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Diagnostics: PAMA

Updated FAQs addressing determination of “applicable laboratory” status

March 01, 2017

Updated FAQs addressing determination of “applicable laboratory” status.

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Diagnostics: Payment Rates

CLFS User guide

January 09, 2017

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Diagnostics: PAMA

Additional Guidance for Clinical Laboratories as Data Reporting Begins

January 05, 2017

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Diagnostics: PAMA

Additional Support Materials from Data Reporting Call

November 23, 2016

EXTERNAL LINK

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Diagnostics: Payment Rates

CMS MLN Matters: FISS Implementation of the Restructured Clinical Lab Fee Schedule

November 18, 2016

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Diagnostics: Regulation

CMS instructs Medicare claims system maintainer to be ready for PAMA based CLFS

November 18, 2016

CMS instructs Medicare claims system maintainer to be ready for PAMA based CLFS.

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Diagnostics

PUB 100-04 Medicare Claims Processing – FISS Implementation of the Restructured Clinical Lab Fee Schedule

November 08, 2016

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Diagnostics: Guidance

CMS Presentation on Data Reporting Required by PAMA

November 02, 2016

PDF DOWNLOAD

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Diagnostics: PAMA

CMS Hosting Conference Call on Data Reporting Required by PAMA

October 12, 2016

The Protecting Access to Medicare Act requires certain laboratories to submit payment data for certain clinical diagnostic laboratory tests to CMS by March 31, 2017.  CMS has promised labs that an online portal would be available to help them submit data and that CMS would provide assistance in helping labs understand their requirements.

ORIGINAL ANALYSIS

Insight: original analysis

CMS Releases Final 2016 Gapfill Lab Payment Rates, CY 2017 Preliminary Crosswalk and Gapfill Determinations

October 05, 2016

The final lab payment amounts for several well-established tests fall well below current Medicare pricing. Stakeholders have until October 30, 2016, to request reconsideration of these rates.

ORIGINAL ANALYSIS

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Diagnostics: Guidance

Changing How Medicare Pays for Clinical Diagnostic Laboratory Tests: An Update on CMS’s Progress (OEI-09-16-00100)

October 04, 2016

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Diagnostics: Guidance

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline data (OEI-09-16-00040)

October 01, 2016

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Diagnostics: Payment Rates

CMS Released Preliminary Crosswalk and Gapfill determinations for CY 2017

September 30, 2016

PDF DOWNLOAD

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Diagnostics: PAMA

CMS Releases Final 2016 Gapfill Determinations

September 30, 2016

EXTERNAL LINK

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Diagnostics: PAMA

Fee-For-Service Data Collection System: Clinical Laboratory Fee Schedule Data Reporting Template

September 12, 2016

PDF DOWNLOAD

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Diagnostics: PAMA

CMS Releases Reporting Template for PAMA Data Reporting

September 12, 2016

CMS has released a reporting template to assist laboratories with fee-for-service data collection.

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Diagnostics: PAMA

Guidance to Laboratories for Collecting and Reporting Data for the Private Payor Rate-Based Payment System

August 10, 2016

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Diagnostics: Guidance

Shape the CPT® Proprietary Lab Analyses Code Set

August 05, 2016

EXTERNAL LINK

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Diagnostics: PAMA

Codes subject to reporting during the first reporting period.

August 05, 2016

Codes subject to reporting during the first reporting period (January 1 – March 30, 2017) (File requires WinZIP to open).

EXTERNAL LINK

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Diagnostics: Payment Rates

September 12th Clinical Diagnostic Laboratory Test Advisory Panel Meeting

August 01, 2016

September 12th Clinical Diagnostic Laboratory Test Advisory Panel Meeting

POST

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Diagnostics: Regulation

CY 2017 Medicare OPPS – Proposed Rule (CMS-1656-P)

July 14, 2016

CMS discusses their proposed laboratory test packaging policy on page 45,628

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Diagnostics: Payment Rates

New and substantially revised test codes to be priced under the (nonPAMA) CLFS beginning January 1, 2017

July 08, 2016

EXTERNAL LINK

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Diagnostics: Regulation

Overview of CMS-1621-F: Medicare Clinical Diagnostic Laboratory Test Payment System Final Rule

July 06, 2016

PDF DOWNLOAD

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Diagnostics

+Dx Webinar: Examining the New Medicare Lab Payment System

June 23, 2016

ORIGINAL ANALYSIS

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Diagnostics: Regulation

Medicare Clinical Diagnostic Laboratory Tests Payment System – Final Rule (CMS-1621-F)

June 23, 2016

PDF DOWNLOAD

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Diagnostics: Payment Rates

Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018

June 17, 2016

EXTERNAL LINK

Insight: original analysis

CMS Finalizes Medicare Laboratory Payment Overhaul

June 03, 2016

Implementing modernization of Medicare payment for lab services

ORIGINAL ANALYSIS

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Diagnostics: Regulation

Diagnostic Tests and Laboratory Operations Hearing Rescheduled

October 26, 2015

E&C Hearing on “Examining the Regulation of Diagnostic Tests and Laboratory Operations” has been rescheduled to Tuesday, November 17, 2015

POST

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Diagnostics: Guidance

Clinical Laboratory Payment System

October 05, 2015

PDF DOWNLOAD

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Diagnostics: Regulation

Medicare Clinical Diagnostic Laboratory Tests Payment System – Proposed Rule (CMS-1621-P)

October 01, 2015

PDF DOWNLOAD

Insight: original analysis

CMS Releases Proposed Plan to Overhaul Medicare Laboratory Payment

September 30, 2015

ORIGINAL ANALYSIS

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Diagnostics: Regulation

Breaking: CMS Releases Anticipated PAMA 216 Regulations

September 25, 2015

The Centers for Medicare and Medicaid Services today posted the long-awaited proposed rule to implement section 216 of the Protecting Access to Medicare Act.

POST

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Diagnostics: Guidance

Medicare Payments for Clinical Laboratory Tests in 2014: Baseline Data

August 01, 2015

PDF DOWNLOAD

Insight: original analysis

Anticipated Framework for Regulatory Oversight of Laboratory Developed Tests

August 07, 2014

ORIGINAL ANALYSIS

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Diagnostics: Legislation

Protecting Access to Medicare Act (PL 113-93)

April 01, 2014

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Diagnostics: Guidance

Comparing Lab Test Payment Rates: Medicare Could Achieve Substantial Savings

June 05, 2013

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Diagnostics: Regulation

42 CFR 414 Subpart G: Medicare Program

October 01, 2011

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Diagnostics: Guidance

Report on Variation in the Clinical Laboratory Fee Schedule

July 05, 2009

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