Laboratory Question for the Week of August 1, 2016

Laboratory Compliance Question of the Week

Question:

I assume that payments for tests will decline under the new lab payment system. Is there any estimate of how much they will decline?

Answer:

For the first three years after implementation of the private payer rate-based clinical laboratory fee schedule, the payment amount for a test cannot drop more than 10 percent (2018–2020) as compared to the previous year’s payment amount. In other words, the change could be a few dollars less than the test is currently paid, according to the directives in the Protecting Access to Medicare Act (PAMA). For example, code 84443 (TSH) has a national limitation amount (NLA) of $22.89. A 10 percent drop would equal $2.28 less. For the subsequent three years, it cannot drop more than 15 percent per year—a drop of $3.42.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.