Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting & Reporting Data for the Private Payor Rate-Based Payment System

MLN Matters Number: SE19006 Revised.

CMS Note: We revised this Article to note that for CDLTs that aren’t ADLTs, the data reporting is delayed by 1 year and must now be reported from January 1, 2023-March 31, 2023 (previously January 1, 2022-March 31, 2022). We’ve changed all references to the 2022 data reporting period to 2023. You’ll find substantive content updates in dark red font (see pages 2,14,15 and 20-23). There are no other changes to the substance of the Article.

Section 105 (a) of the Further Consolidated Appropriations Act, 2020 (FCAA) (Pub. L. 116-94, enacted December 19, 2019) and Section 3718 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. 116-136, enacted March 27, 2020) made several revisions to the next data reporting period for CDLTs that aren’t Advanced Diagnostic Laboratory Tests (ADLTs) and the phase-in of payment reductions under the Medicare private payor rate-based CLFS. On December 10, 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) further delayed the reporting requirement under Section 1834A of the Act and also delayed the application of the 15% phase-in reduction. In summary the revisions are: 

• We’ll base the next data reporting period of January 1, 2023-March 31, 2023, on the original data collection period of January 1, 2019-June 30, 2019. 
• After the next data reporting period, there’s a 3-year data reporting cycle for CDLTs that aren’t ADLTs, (that’s, 2026, 2029, and so on). 
• The statutory phase-in of payment reductions resulting from private payor rate implementation is extended through Calendar Year (CY) 2024. There was a 0.0% reduction for CY 2021, and we won’t reduce payment by more than 15% for CYs 2023- 2025. 

Also, for the January 1, 2023-March 31, 2023 (previously January 1, 2022-March 31, 2022) data reporting period, we allow reporting entities the option to condense certain applicable information at the Tax Identification Number (TIN)-level, instead of reporting for each applicable laboratory individually at the National Provider Identifier (NPI) level.