The Centers for Medicare and Medicaid Services (CMS) has revised its Medicare Part B clinical laboratory fee schedule for the collection and reporting of private payer-based rate information for clinical diagnostic laboratory tests. The revision applies to data that private laboratories are federally mandated to report to CMS under Section 1834A of the Social Security Act, as established by Section 216 of the Protecting Access to Medicare Act of 2014.

The current revisions come as part of Section 105(a) of the Further Consolidated Appropriations Act of 2020 and Section 3718 of the Coronavirus Aid, Relief, and Economic Security Act. They apply to clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests and to the phase-in of payment reductions under the Medicare private payer rate-based clinical laboratory fee schedule.

CMS delayed the data reporting period by one year. Originally scheduled for the period of Jan. 1, 2022, through March 31, 2022, the next data reporting period will now take place from Jan. 1, 2023, through March 31, 2023. The reporting will be based on the original data collection period, from Jan. 1, 2019, through June 30, 2019.

Following the next data reporting period, the cycle for clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests will follow three-year intervals, with the next period scheduled for 2026.

CMS also extended the statutory phase-in of payment reductions resulting from private payer rate implementation through 2024. Payments will not be reduced by more than 15 percent for the calendar years of 2023, 2024, and 2025.

It was also reported that for the next data reporting period (Jan. 1, 2023, to March 31, 2023), reporting entities will be allowed to condense applicable information at the Tax Identification Number level, rather than requiring a report from each individual laboratory at the National Provider Identifier level.