How will the proposed Medicare Physician Fee Schedule potentially impact labs?


As the pandemic continues, testing will remain a fundamental aspect for monitoring COVID-19. CMS recognizes the feedback and need to empower local authorities with sufficient diagnostic testing capabilities and help them continue to expand their reach for Medicare beneficiaries. As part of this ongoing effort, the agency updated the Medicare payment rules so that payment was established for independent laboratories when specimen collection was completed from homebound beneficiaries along with inpatients who did not undergo COVID-19 testing in a hospital setting under specific conditions.

Under these scenarios, CMS increased payment from $3–5 to $23–25. Stakeholders like the College of American Pathologists (CAP) are looking for clarification regarding the specific specimen collection fee policies. In addition, they are seeking an understanding of the impacts of travel allowances and calculation costs involving transportation and incurred personal expenses for the required personnel who are collecting specimens following the end of the public health emergency (PHE). For 2022 and potentially beyond, the proposed regulation in the MPFS reveals that CMS could permanently cement the policy option for laboratories to sustain the electronic log of miles traveled that covers both transportation and personnel expenses for the appropriate personnel who are conducting the collection of specimen samples.

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