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.