What is the Medicare policy for packaging of laboratory tests?


Under the current policy, certain clinical diagnostic laboratory tests (CDLTs) that are listed on the Clinical Laboratory Fee Schedule (CLFS) are packaged, according to the Centers for Medicare & Medicaid Services (CMS), as “integral, ancillary, supportive, dependent, or adjunctive to the primary service or services provided in the hospital outpatient setting during the same outpatient encounter and billed on the same claim.”

Specifically, CMS conditionally packages most CDLTs and only pays separately for a laboratory test when it is:

  • The only service provided to a beneficiary on a claim
  • Considered a preventive service
  • A molecular pathology test
  • An advanced diagnostic laboratory test (ADLT) that meets certain regulatory criteria.

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.


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