Medicare Finalizes a New Clinical Laboratory Test Payment System

CMS has posted the long anticipated final rule implementing a new Medicare payment system for clinical diagnostic laboratory tests, based on rates paid by private payers. Under the new system, required by the Protecting Access to Medicare Act of 2014 (PAMA), certain labs have to report to CMS the rates they are paid by private payers for each test they perform, and Medicare rates will be based on the weighted median of these reported rates. For most lab tests, private payer rates will be reported, and Medicare rates updated, every 3 years. CMS had proposed using the new rates in 2017, but due to delays in the rulemaking process, they have pushed back implementation to January 2018, based on rates paid by private payers in 2016.

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