CMS Delays Clinical Lab Fee Schedule Data Reporting, Cuts Capped at 15% for 2021

Data that was set to be gathered between Jan. 1, 2020, and March 31, 2020, is now delayed until the period between Jan. 1, 2021, and March 31, 2021, after which reporting will continue on the normal three-year cycle, according to CMS. But PAMA cuts are set to continue in the meantime. 

“Rather than waiting for the new data, however, CMS is now indicating it will base 2021 lab rates off of data collected in 2017,” Assaraf wrote. “While this development may be disappointing for clinical labs, it’s worth noting that the majority of PAMA cuts will likely be realized by the end of 2020, as it is the third year of cuts capped at 10% (for a total of 30%).”

• Synopsis: CMS said Thursday it is delaying data reporting for clinical diagnostic laboratory tests, used to inform development of the clinical laboratory fee schedule, by one year until 2021.
• Despite the delay, CMS said Protecting Access to Medicare Act cuts to clinical lab tests will not be frozen, with 2021 lab reimbursement based on data reporting from 2017. Cuts to lab fee schedule rates in 2020 are capped at 10%, but the reduction cap is set to rise to 15% in 2021.

Cowen Washington Research Group’s Eric Assaraf wrote the decision to maintain the status quo on expected cuts comes despite hope by labs the agency would freeze rates in 2021.

Source: https://www.medtechdive.com/news/cms-delays-clinical-lab-fee-schedule-data-reporting-cuts-capped-at-15-for/569764/