Clinical Laboratory Fee Schedule & Laboratory Services Subject to Reasonable Charge Payment

Key Updates:

ADLTs

See CMS ADLT for more information about these tests.

ADLTs

The new codes table in CR 14055 lists new codes effective July 1, 2025

These codes were added to the HCPCS file with an effective date of July 1, 2025. MACs don’t need to manually add these codes to the HCPCS file. However, these new codes are MAC-priced (where applicable) until they’re nationally priced and undergo the CLFS annual payment determination process per sections 1833(h)(8), 1834(A)(c), and 1834(A)(f) of the Social Security Act. MACs only price proprietary laboratory analyses codes for laboratories within their jurisdiction.

Deleted Codes

The deleted codes table in CR 14055 lists codes we deleted effective July 1, 2025.

Note: MACs won’t search their files to retract payment or retroactively pay claims but will adjust
claims you bring to their attention.

Source: https://www.cms.gov/files/document/mm14055-clinical-laboratory-fee-schedule-laboratory-services-subject-reasonable-charge-payment-july.pdf