Question:
Is CMS using mostly hospital data to determine the new CLFS rates?
Answer:
According to an analysis by the Department of Health & Human Services Office of Inspector General (OIG), in 2015, independent labs accounted for 55 percent of the Medicare Part B payments for lab tests, hospital labs accounted for 24 percent, and physician office labs accounted for the remaining 20 percent.
Therefore, says the OIG’s report, the new payment rates for lab tests will be based primarily on private payer data from independent labs. It also states that new payment rates will be based on data provided by a projected 5 percent of labs—labs that received 69 percent of Medicare payments in 2015.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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