CMS has posted preliminary Medicare clinical laboratory fee schedule rates for 2018 – the first year rates will be based on private payer data under the Protecting Access to Medicare Act of 2014 (PAMA). CMS estimates that 2018 Medicare Part B payments will be reduced by about $670 million for calendar year 2018. In fact, for approximately 75 percent of the HCPCS codes on the CLFS, the 2018 rate based on the weighted median of private payor rates is a decrease from the CY 2017 CLFS national limitation amount. CMS will accept comments on preliminary rates until October 23, 2017.
CMS also posted preliminary determinations regarding the payment basis (crosswalk or gapfill) for new and existing laboratory HCPCS codes for which CMS received no applicable payment information. Comments on the preliminary determination also are due October 23, 2017.
This article is presented for informational purposes only and is not intended to constitute legal advice.
