Fee-For-Service Data Collection System: Clinical Laboratory Fee Schedule Data Reporting Template

Section 1834A of the Social Security Act, added by Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA), significantly changes how Medicare payment rates are set for clinical diagnostic laboratory tests (CDLTs) paid under the Medicare Clinical Laboratory Fee schedule (CLFS). In general, CMS will establish Medicare payment rates for CDLTs on the Clinical Laboratory Fee Schedule (CLFS) based on the weighted median of the rates that private payors pay for the test during a specified data collection period. Applicable laboratories must collect applicable information (that is, private payor rates and associated volume for covered tests identified by HCPCS codes) for the period beginning January 1, 2016, through June 30, 2016. Applicable laboratories must report their data to CMS beginning January 1, 2017, through March 31, 2017. CMS will use this data to calculate payment rates for the calendar year 2018 CLFS update. The CLFS data reporting template provides the required data fields for reporting applicable information for the CLFS private payor rate-based system. “Comma Separated Value” (.csv) is the available format for data submission through a file upload process. Alternatively, data may be submitted through an online interface. Data must be reported to CMS through the Fee-For-Service Data Collection System (FFSDCS) CLFS System at https://portal.cms.gov.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1620.pdf