CMS Issues 2016 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

The Centers for Medicare & Medicaid Services (CMS) has issued a new change request (CR) that should be of interest to clinical diagnostic laboratories that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

CR 9465 provides instructions for the calendar year (CY) 2016 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests and updates for laboratory costs subject to the reasonable charge payment.

Key points of CR 9465 address:

  • national minimum payment amounts;
  • national limitation amounts (maximum);
  • pricing information;
  • organ or disease oriented panel codes;
  • mapping information;
  • blood product codes;
  • transfusion medicine codes; and
  • reproductive medicine procedure codes.

CR 9465 was released less than a month after CMS released its final 2016 clinical lab fee schedule (access the 2016 fee schedule files here).

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