New law will modernize Medicare lab payments: What physicians need to know

  • April 23, 2014

Medicare will make sweeping changes in how it pays for clinical laboratory tests starting in 2017. The Protecting Access to Medicare Act, enacted April 1, will make the most significant reform of Medicare’s Clinical Laboratory Fee Schedule (CLFS) since its introduction in 1984, by setting CLFS payment amounts based on rates paid for laboratory tests in the private sector.

Medicare’s payment amounts for pathology laboratory services paid under Medicare’s physician fee schedule (PFS) will be unchanged by the new law. Also unchanged will be Medicare’s policy of not imposing coinsurance on CLFS tests. The possibility of imposing coinsurance has been frequently proposed in discussions about reform of the CLFS, but the new law leaves that policy — and hence the financial burden of lab testing on Medicare beneficiaries — unchanged.

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