The Centers for Medicare & Medicaid Services announced that on Dec. 29, 2022, Section 4114 of the Consolidated Appropriations Act, 2023, revised the next data reporting period for clinical diagnostic laboratory tests (CDLTs) that are not advanced diagnostic laboratory tests (ADLTs). It also revised the phase-in of payment reductions under the Medicare private payer rate-based Clinical Laboratory Fee Schedule (CLFS). The next data reporting period under the Protecting Access to Medicare Act (PAMA) will be Jan. 1, 2024, through March 31, 2024. It will be based on the original data collection period from Jan. 1, 2019, through June 30, 2019. After this next data reporting period, there will be a three-year data reporting cycle for CDLTs that are not ADLTs (e.g., 2027, 2030, etc.).
Section 1834 of the Consolidated Appropriations Act required changes to the way Medicare pays for CDLTs under the CLFS. According to the CLFS final rule, reporting entities must report certain private payer rate information or other applicable information to CMS for their component applicable laboratories. The statutory phase-in of payment reductions resulting from private payer rate implementation is extended through 2026. For 2021, 2022, and 2023, there is a 0.0 percent reduction; payment may not be reduced by more than 15 percent for 2024 through 2026. More information on the PAMA regulations, including a table indicating the reduction caps for specific data collection and reporting periods, is available on the CMS website.
Source:
https://www.cms.gov/medicare/medicare-fee-for-service-payment/clinicallabfeesched/pama-regulations
