Question:

Why does CMS exclude molecular pathology lab tests from packaging under the OPPS?

Answer:

In the 2016 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule, CMS excluded all molecular pathology laboratory tests from packaging because it believes “these relatively new tests may have a different pattern of clinical use, which may make them generally less tied to a primary service in the hospital outpatient setting than the more common and routine laboratory tests that are packaged.”

For similar reasons, CMS extended, in the 2017 OPPS and ASC final rule, the exclusion to also apply to all advanced diagnostic laboratory tests (ADLTs) that meet certain criteria. A designated ADLT will be assigned status indicator “A” (separate payment under the CLFS).


This question was answered in the December 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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