CHA News Article

CMS Issues Final Clinical Laboratory Fee Schedule Rates for 2018

The Centers for Medicare & Medicaid Services (CMS) last week issued final Medicare payment rates for clinical diagnostic laboratory tests and advanced diagnostic laboratory tests paid under the clinical laboratory fee schedule in calendar year 2018. Despite concerns raised by CHA and other stakeholders about the private payer data collected to calculate the new rates, CMS made few modifications to its preliminary payment rates. As required by the Protecting Access to Medicare Act of 2014, the rates are based on a weighted median of private insurer payment rates paid to applicable laboratories. Additional information on the definition of applicable laboratories for reporting purposes is available in the final rule issued in June 2016.

The rates are effective for laboratory tests paid under the clinical laboratory fee schedule beginning Jan. 1. CHA recently issued hospital-specific DataSuite analyses of the preliminary payment rates, intended to show the impact of the new rates for calendar years 2017 to 2023. 

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