MM12080 – Calendar Year (CY) 2021 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

Clinical Laboratory Fee Schedule Update to Fees In accordance with Section 1833(h)(2)(A)(i) of the Act, the annual update to the local clinical laboratory fees for CY 2021 is 0.20%. Beginning January 1, 2021, this update applies only to pap smear tests. For a pap smear test, Section 1833(h)(7) of the Act requires payment to be the lesser of the local fee or the National Limitation Amount, but not less than a national minimum payment amount. However, for pap smear tests, payment may also not exceed the actual charge. The CY 2021 national minimum payment amount is $15.15 (This value reflects the CY 2020 national minimum payment with a 0.2% increase or $15.12 times 1.0020). The affected codes for the national minimum payment amount are: 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88164, 88165, 88166, 88167, 88174, 88175, G0123, G0143, G0144, G0145, G0147, G0148, Q0111, Q0115, and P3000. The annual update to payments made on a reasonable charge basis for all other laboratory services for CY 2021 is 0.6% (See 42 CFR 405.509(b)(1)). The Part B deductible and coinsurance do not apply for services paid under the CLFS.

Proprietary Laboratory Analysis (PLAs) New Codes Effective January 1, 2021 PLAs: The following new codes have been added to the national HCPCS file with an effective date of January 1, 2021. These new codes are contractor-priced until they are addressed at the annual Clinical Laboratory Public Meeting, which will take place in June or July of 2021, as they were received after the 2020 public meeting. MACs will only price PLA codes for laboratories within their jurisdiction.

• CPT Code; 0227U

• CPT Code: 0228U

• CPT Code: 0229U

• CPT Code: 0230U

• CPT Code: 0231U

• CPT Code: 0232U

• CPT Code: 0233U

• CPT Code: 0234U

• CPT Code: 0235U

• CPT Code: 0236U

• CPT Code: 0237U

• CPT Code: 0238U

• CPT Code: 0239U

CR Transmittal Number: R10523CP

Source: https://www.cms.gov/files/document/MM12080.pdf