Medicare Program; Medicare Clinical Diagnostic Laboratory Tests Payment System. Final rule

Area of Science:

• Health Policy
• Medical Economics
• Clinical Diagnostics

Background:

• The Protecting Access to Medicare Act of 2014 (PAMA) introduced significant changes to Medicare.
• Previous Medicare payment systems for laboratory tests required updates.

Purpose of the Study:

• To implement Section 216 of PAMA.
• To announce the implementation of a new Medicare payment system for clinical diagnostic laboratory tests.

Main Methods:

• Final rule implementation.
• Announcement of a new fee schedule.

Main Results:

• The Medicare payment system for clinical diagnostic laboratory tests is revised.
• A January 1, 2018 implementation date is set for the private payor rate-based fee schedule.

Conclusions:

• The new PAMA requirements are being enacted.
• The updated Medicare payment system aims to reflect private payor rates for laboratory tests.