Laboratory Question for the Week of December 26, 2022

Question:

Are there any updates regarding the Clinical Laboratory Fee Schedule for 2023?

Answer:

CMS approved certain conforming changes to the data reporting and payment requirements for the clinical laboratory fee schedule (CLFS) at 42 CFR 42 CFR part 414, subpart G that align with policies in section 4(b) of the Protecting Medicare and American Farmers from Sequester Cuts Act. CMS states: “Specifically, we are finalizing revisions to §414.502 to update the definitions of both the ‘data collection period’ and ‘data reporting period,’ specifying that for the data reporting period of January 1, 2023, through March 31, 2023, the data collection period is January 1, 2019, through June 30, 2019. We are also finalizing revisions to §414.504(a)(1) to indicate that initially, data reporting begins January 1, 2017, and is required every 3 years beginning January 2023. In addition, we are finalizing conforming changes to our requirements for the phase-in of payment reductions to reflect the amendments in section 4(b) of this law. Specifically, we are finalizing revisions to §414.507(d) to indicate that for CY 2022, payment may not be reduced by more than 0% as compared to the amount established for CY 2021, and for CYs 2023 through 2025, payment may not be reduced by more than 15 percent as compared to the amount established for the preceding year.” CMS weighed public feedback and analysis and factored these into their final decision to raise the nominal fee for specimen collection based on the Consumer Price Index for all Urban Consumers (CPI-U). Starting in 2023, the general specimen collection fee will rise from $3 to $8.574. Even more, as mandated by PAMA, expect to see the amount increased by $2 for those specimens collected from a Medicare beneficiary in a SNF or by a laboratory on behalf of an HHA. Ultimately, this decision will lead to a $10.57 specimen collection fee for those beneficiaries.

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