Demonstration Test List is now available

The Affordable Care Act mandates a Demonstration to allow a separate payment to laboratories performing certain complex laboratory tests billed with a date of service that would under standard Medicare rules be bundled into the payment to the hospital or critical access hospital (CAH). The Demonstration period is limited to 2 years subject to a $100 million total payment limit. The Demonstration Test List contains the HCPCS code and payment rate for about 35 diagnostic laboratory tests that would meet these criteria. However, there are tests that would meet the criteria for being complex diagnostic laboratory tests except that they are billed under Medicare using NOC codes, because the current payment rate setting method of gap filling and cross walking is not applicable to these tests. To participate in the Demonstration, test developers must obtain a temporary G-code from CMS for these NOC codes.