In a quarterly update for the Clinical Laboratory Fee Schedule (CLFS) and laboratory services, the Centers for Medicare & Medicaid Services (CMS) reminds providers billing Medicare Administrative Contractors (MACs) that the next private payer data reporting period is Jan. 1 to March 31, 2025, based on the original data collection period of Jan. 1 to June 30, 2019.
The data reporting requirements for clinical diagnostic laboratory tests (CDLTs) that are not advanced diagnostic laboratory tests (ADLTs) were previously delayed based on Section 502 of the Further Continuing Appropriations and Other Extensions Act of 2024. A three-year data reporting cycle will be implemented for CDLTs that are not ADLTs after the next reporting period (i.e., 2028, 2031).
The phase-in of payment reductions under the CLFS from private payer rate implementation was also delayed. CMS stated that a 0 percent payment reduction will be applied for calendar year (CY) 2024, “so that a CDLT that isn’t an ADLT won’t be reduced compared to the payment amount for that test in CY 2023.” The agency will not reduce payment by more than 15 percent per year from the previous year for CYs 2025 to 2027.
Also in the July 18 quarterly report, CMS announced new codes in CR 13717 effective Oct. 1. Until the codes are nationally priced through the CLFS annual payment determination process, the codes are MAC-priced where applicable. Also effective Oct. 1, two codes will be deleted from CR 13717: CPT code 0167U (gonadotropin, chorionic [hCG], immunoassay with direct optical observation, blood) and CPT code 0396U (obstetrics [preimplantation genetic testing]).
Sources: