Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

The revised CR deleted code 0008U from the list of revised codes effective January 1, 2019.

Next CLFS Data Collection Period:

Section 1834A of the Social Security Act (“the Act”), as established by Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), required significant changes to how Medicare pays for Clinical Diagnostic Laboratory Tests (CDLTs) under the CLFS. The CLFS final rule, “Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule,” (CMS-162-F) was published in the Federal Register on June 23, 2016. The CLFS final rule implemented Section 1834A of the Act.

Under the CLFS final rule, reporting entities must report to the Centers for Medicare & Medicaid Services (CMS) certain private payer rate information (applicable information) for their component applicable laboratories. The next data collection period (the period where applicable information for an applicable laboratory is obtained from claims for which the laboratory received final payment during the period) is from January 1, 2019, through June 30, 2019, and the next 6-month window is July 1, 2019, through December 31, 2019 (the period where laboratories and reporting entities assess whether the applicable laboratory thresholds are met and review and validate applicable information before it is reported to CMS).

The next data-reporting period is January 1, 2020, through March 31, 2020, where applicable information is reported to CMS. This data will be used to calculate revised private payer rate-based CLFS rates, effective January 1, 2021. Specific directions on data collection and data reporting are available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/PAMA-regulations.html.

CR:11076

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11076.pdf