Rates for Pathology and Laboratory Services Restricted

Effective retroactively for dates of service on or after January 1, 2014, the reimbursement rates for certain laboratory and pathology services that were higher than 80 percent of the 2014 Medicare rate will change. Claims processed for dates of service on or after January 1, 2014, will be subject to the updated rates. An Erroneous Payment Correction (EPC) will be initiated to adjust those claims previously processed under the higher rate. However, any claims reprocessed after this rate update will be subject to the most current rate. Per Welfare and Institutions Code (W&I Code), Section 14105.22, reimbursement for clinical laboratory and laboratory services, as described in the California Code of Regulations (CCR), Title 22, Section 51137.2, may not exceed 80 percent of the lowest maximum allowance established by the federal Medicare program for the same or similar services.