Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration

This notice informs laboratories of an opportunity to participate in the section 3113 Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration. The authorizing legislation requires CMS to conduct a Demonstration for a period of 2 years subject to a $100 million ($100,000,000) limit. The Demonstration will allow a direct payment to a laboratory for certain complex diagnostic laboratory tests in situations where, under the date of service rule, Medicare pays the hospital or CAH and the hospital or CAH, in turn, pays the laboratory (“under arrangement”) for laboratory tests.

This notice also serves to notify laboratories that they must obtain a temporary G code from CMS for tests currently billed using NOC codes that would otherwise meet the criteria set forth in section 3113(a)(2). Information about these tests is due to CMS no later than August 1, 2011. The purpose of the August deadline is to allow time for CMS to determine whether the test meets the criteria for a complex clinical laboratory test and to determine appropriate payment amounts for tests paid under the Demonstration. Payment under the Demonstration will begin on January 1, 2012.

Source: [FR Doc. 2011-16721 Filed 07/01/2011 at 8:45 am; Publication Date: 07/05/2011]