Medicare Laboratory Reimbursement

For information on the Medicare Clinical Laboratory Fee Schedule, click here.

September 2, 2014 - ASM Provides Comments on CME and LCD
ASM commented on “Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015” as published in the July 11 Federal Register.   The comments focus on proposed changes in continuing medical education (CME) and the local coverage determination (LCD) process for laboratory testing.

July 14, 2014 - ASM Provides Comments on the Protecting Access to Medicare Act to CMS
ASM provided comments to the Centers for Medicare & Medicaid Services (CMS) regarding Section 1834A, “Improving Policies for Clinical Diagnostic Laboratory Tests,” added to the Social Security Law by the Protecting Access to Medicare Act of 2014 (PAMA).

November 12, 2013 - ASM Signs CLC Letter Urging CMS to Enter into Negotiated Rulemaking
The ASM signed onto a letter from the Clinical Laboratory Coalition urging the Congress to consider legislation requiring the Centers for Medicare and Medicaid Services (CMS) to enter into negotiated rulemaking with stakeholders to develop an updated clinical laboratory fee schedule. (Background: Federal Register Notice)

September 6, 2013 - ASM Comments on CMS Proposed Revisions to the PFS and CLFS
ASM provided comments to the Centers for Medicare & Medicaid Services (CMS) regarding proposed revisions to payment policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014 [CMS-1600-P] published in the Federal Register on July 19, 2013.  ASM commented specifically on revisions to the Clinical Laboratory Fee Schedule.

September 6, 2013 - ASM Submits Comments to CMS on Outpatient Prospective Payments
The ASM submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding proposed revisions to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs for CY 2014 (CMS-1601-P), which was published in the Federal Register on July 19, 2013.  ASM focused its comments on the section in the proposed rule regarding clinical laboratory services

October 16, 2012 - CMS Announces New Molecular Billing Codes
CMS published Revisions to Payment Policies under the Physician Fee Schedule.   This comprehensive revision places some 115 newly created molecular pathology Current Procedural Terminology (CPT) codes under the Clinical Laboratory Fee Schedule (CLFS) for 2012-2013. In addition, a new code, G0452, has been set aside for use when physician interpretation of a molecular pathology procedure is medically necessary. This G code has been designated as an interim code on the Physicians Fee Schedule (PFS) and will be monitored by CMS throughout calendar year 2013.   There is no corresponding code for interpretation by a doctoral level scientist or other appropriately trained nonphysician health care professional on either the CLFS or the PFS since they do not have a Medicare benefit category that allows them to bill and be paid for their interpretation services.

October 1, 2012 - CMS Announces New Waived Tests
On Oct 1, The Centers for Medicare and Medicaid Services (CMS) updated the list of Clinical Laboratory Improvements Act (CLIA) waived tests. The updated list includes eleven new FDA approved waived tests; they include tests for Influenza A+B, Strep A, and Borrelia burgdorferi and Helicobacter pylori antibodies. As defined by CLIA, waived tests are categorized as “simple laboratory examinations and procedures that have an insignificant risk of an erroneous result.”

October 9, 2009 - ASM Comments on CMS Proposed Decision Memo for Screening for the Human Immunodeficiency Virus (HIV) Infection
The ASM submitted comments to the Centers for Medicare & Medicaid Services on its “Proposed Decision Memo for Screening for the Human Immunodeficiency Virus (HIV) Infection (CAG-00409N).”

July 17, 2008 - UPDATE: Competitive Bidding Demonstration Project for Clinical Laboratory Services Repealed

June 13, 2008 - ASM Submits Comments to CMS on Proposed Rule on Hospital Acquired Infections
The ASM submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding its proposed rule, "Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates" which was published in the Federal Register on April 20, 2008. ASM focused its comments on the section in the proposed rule regarding hospital acquired infections.

April 8, 2008 - Update on the Competitive Bidding Demonstration Program for Medicare Clinical Laboratory Services
On April 8, United States Federal District Court Judge, Thomas J. Whelan granted a preliminary injunction on the U.S. Department of Health and Human Services, prohibiting CMS from announcing bid winners, otherwise implementing and carrying out the demonstration project in the San Diego metropolitan area, and further disclosing any information included in the bid applications. The decision was timely in that CMS was supposed to announce bid winners for the San Diego demonstration site on April 11. Because a preliminary injunction only delays the implementation of the demonstration until further Court order, it is critical that Congress act to provide a permanent solution by enacting legislation to repeal the Medicare Competitive Bidding Demonstration Program for Clinical Laboratory Services. The ASM asked its clinical members to contact Congress to support H.R. 3453 and S. 2099.

October 18, 2007 - Update on Competitive Bidding Demonstration Project for Medicare Clinical Laboratory Services

September 25, 2007 - ASM Comments on Publication of Medically Unlikely Edits (MUEs)
On September 25, the ASM sent a letter to Medicare contractor, Correct Coding Solutions, LLC to encourage the public release of Medically Unlikely Edits (MUEs).

August 17, 2007 - ASM Comments on Phase V Implementation of Medically Unlikely Edits (MUEs)
The ASM submitted comments to Medicare contractor, Correct Coding Solutions (CCI) on Phase V, Medically Unlikely Edits, scheduled to be implemented on January 1, 2008.

June 25, 2007 - ASM Sends Comments to OMB Regarding CMS's Draft Advanced Beneficiary Notice
On June 25, the ASM sent comments to the Office of Management and Budget (OMB) regarding the Centers for Medicare & Medicaid Services (CMS) revised Advanced Beneficiary Notice (ABN).

June 12, 2007 - ASM Submits Comments on CMS Proposed Rule Regarding Hospital Acquired Infections
The ASM submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding its proposed rule, "Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates" which was published in the Federal Register on May 3, 2007. ASM focused its comments on the section in the proposed rule regarding hospital acquired infections.

May 29, 2007 - ASM Comments on Phase IV Implementation of Medically Unlikely Edits (MUEs)
ASM submitted comments to Medicare contractor, Correct Coding Solutions (CCI) on Phase IV, Medically Unlikely Edits, scheduled to be implemented on October 1, 2007.

March 21, 2007 - ASM Comments on Phase III Implementation of Medically Unlikely Edits (MUEs)
ASM submitted comments to Medicare contractor, Correct Coding Solutions (CCI), on the Phase III of Medically Unlikely Edits (MUEs), scheduled to be implemented on July 1, 2007.

January 8, 2007 - ASM Comments on Phase II Implementation of Medically Unlikely Edits (MUEs)
ASM submitted comments to Medicare contractor, Correct Coding Solutions (CCI), on the Phase II Implementation of Medically Unlikely Edits (MUEs), scheduled for April 1, 2007. ASM's statement reiterates comments previously submitted on June 19, 2006.

June 19, 2006 - ASM Joins Effort to Express Concern over MUE Proposal
The ASM sent a letter to Medicare Contractor, Correct Coding Solutions to comment on the impact the "medically unbelievable edits" (MUE) proposal would have on laboratory testing and patient care. The ASM also signed onto two coalition letters that were sent to Mark McClellan, MD, PhD, Administrator of the Centers for Medicare and Medicaid Services (CMS) to express concern over MUE's, intended to prevent overpayments resulting from obviously erroneous Medicare claims submissions.

May 11, 2005 - ASM Comments to SACGHS on Coverage and Reimbursement of Genetic Tests and Services
PSAB's Committee on Professional Affairs submitted comments to the Secretary's Advisory Committee on Genetics, Health and Society (SACGHS) regarding its draft report on coverage and reimbursement of genetic tests and services.

November 14, 2003 - ASM Letter to Medicare Conferees
The ASM sent a letter to House and Senate Medicare Conferees urging them to oppose cuts that would adversely affect clinical laboratories, such as co-payments for laboratory testing, a freeze on cost of living adjustments to Medicare payments laboratory services, and/or further reductions in the reimbursement of laboratory tests covered by Medicare.

Negotiated Rulemaking for Laboratory Testing

 

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