Call to Explain 2020 Reporting Under Clinical Diagnostic Test Payment System Final Rule

Posted on October 31, 2019

The Centers for Medicare & Medicaid Services (CMS) will host a call from 2 to 3 p.m. EST Nov. 14 for clinical diagnostic laboratories, including hospital outreach laboratories, regarding data reporting for the Clinical Diagnostic Test Payment System in 2020.

The 2019 physician fee schedule final rule defined many hospital outreach laboratories as "applicable laboratories" under the Clinical Laboratory Fee Schedule (CLFS), requiring them to collect private payer payment rates and volumes in 2019 and report the data in 2020. The CMS will use this data to set Medicare payment rates effective Jan. 1, 2021. Additional information is available on the Protecting Access to Medicare Act of 2014 (PAMA) Regulations webpage. Laboratories, including physician office laboratories and hospital outreach laboratories that bill using a 14X Type of Bill, are required to report laboratory test HCPCS codes, associated private payer rates and volume data if they meet both of the following criteria:

  • Have more than $12,500 in Medicare revenues from laboratory services on the CLFS.
  • Receive more than 50 percent of their Medicare revenues from CLFS and physician fee schedule services during a data collection period.

 Registration is required to participate in the call. MHA members with questions should contact Vickie Kunz at the MHA.

Tags: Medicare, CMS, CLFS, Vickie Kunz, PAMA

Posted in: Member News

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