2015 Rate Adjustment for Laboratory and Pathology Services

In compliance with Welfare and Institutions Code (W&I Code), Section 14105.22, Medi-Cal maximum reimbursement rates for clinical laboratory or laboratory services may not exceed 80 percent of the lowest maximum allowance established by the federal Medicare program for the same or similar services. Effective retroactively for dates of service on or after January 1, 2015, reimbursement rates for laboratory and pathology services that exceeded 80 percent of the 2015 Medicare rate will be adjusted. An Erroneous Payment Correction will be initiated to adjust claims previously processed under the higher rate.