Final 2018 Clinical Laboratory Fee Schedule Rates Are Now Available

The Centers for Medicare and Medicaid Services (CMS) has released the 2018 clinical laboratory fee schedule (CLFS) rates.

The rates were calculated based on private payer data that was reported to CMS by certain applicable laboratories, as required by the Protecting Access to Medicare Act (PAMA) of 2014. This process was initiated so that CMS could more closely align Medicare payment rates with those of private payers. Learn more about the data collection process in this PAMED article.

CMS used the reported data to calculate a weighted median per test. Beginning in 2018, the CLFS will be aligned to the weighted median, phased in at a maximum of 10 percent reduction each year until 2020, and 15 percent in years 2021-2023.

The new payment schedule will begin on Jan. 1, 2018 and will apply to anyone billing under the CLFS, not just those applicable laboratories required to report pricing data. For tests typically performed in a physician’s office, most revised payment amounts are lower than current rates. Although there will be a maximum reduction 10 percent per year, physicians and practices should expect additional reductions over time.

CMS offers a spreadsheet that lists HCPCS codes, weighted median data, and payment data for 2018-2020. Access it here to determine how payment for the codes you use will be affected.

For more details on the 2018 CLFS rates, visit CMS’ webpage here.

Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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