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CMS Publishes Final Clinical Laboratory Fee Schedule for 2023

by | Nov 7, 2022 | News, Open Content

The Final Rule caps future PAMA cuts at 15 percent per calendar year.

On Nov. 1, the Centers for Medicare and Medicaid Services (CMS) published the 2023 Physician Fee Schedule Final Rule (Final Rule) containing the 2023 Medicare Part B Clinical Laboratory Fee Schedule (CLFS). Here’s a quick briefing of the four key CLFS provisions lab managers should be aware of.

1. PAMA Price Reporting Changes

Finalizing changes affecting price reporting under PAMA (as amended by the Protecting Medicare and American Farmers from Sequester Cuts Act), the Final Rule states that for the “data reporting period of January 1, 2023 through March 31, 2023”, the “data collection period” is January 1, 2019 through June 30, 2019. Translation: Labs must base their 2023 first quarter PAMA pricing reporting on data from the first six months of 2019. The Final Rule also clarifies that initially, data reporting started on January 1, 2017, and is required every three years, beginning in January 2023.

2. 15 Percent Cap on 2023 to 2025 Rate Cuts

The Final Rule makes last year’s freeze on CLFS rate cuts official by specifying that payment for 2022 may not be reduced by more than 0 percent, as compared to 2021. Going forward, it limits rate cuts for a single year between 2023 to 2025 to 15 percent, as compared to the previous calendar year. Translation: Scheduled PAMA cuts that were deferred in response to the COVID-19 pandemic are going to take effect, but subject to a 15 percent cap over the next three years.

3. Increase to Specimen Collection Fee

The 2023 general specimen collection fee will increase a robust $3 to $8.57; as required by PAMA, that amount will increase another $2, to $10.57, for specimens collected from a Medicare beneficiary in a skilled nursing facility or a lab on behalf of a home health agency. Future increases will be indexed to percentage changes in the Urban Consumer Price Index (CPI-U).

4. Revised CLFS Travel Allowance Rules

The Final Rule also clarifies the methodology that CMS uses to calculate the travel allowance for specimen collection from patients who are homebound or admitted as inpatients by adding new regulations governing:

  • General requirements;
  • Travel allowance basis requirements; and
  • Travel allowance amount requirements.

Learn more in this December 2022 National Lab Reporter article, posted in advance of PDF publication.