Last Updated: Dec 1, 2017
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.
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
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’
Society (PAMED) members with questions can also contact our Knowledge Center at
855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.