By Christopher P. Young, Editor, G2 Compliance Advisor
While a quarter of a percent reduction in laboratory fees in 2015 doesn’t sound like much, when spread over thousands of tests it can have a meaningful impact on a laboratory’s bottom line. Centers for Medicare and Medicaid Services (CMS) transmittal R3152CP, issued Dec. 19, 2014, effective date Jan. 1, explains how CMS came to the -0.25 percent update to the clinical laboratory fee schedule (CLFS) and includes other information for more specialized test services such as those paid on a reasonable charge basis.
The negative update will also apply to the national minimum payment for pap smears reducing the limit to $14.38 from $14.42 in 2014. According to the transmittal, laboratory tests paid on a reasonable charge basis will see a 2.1 percent update.
Laboratories doing drug testing will have to pay particular attention to the changes in Current Procedural Terminology (CPT) codes for that testing. The American Medical Association CPT Editorial Panel made significant changes to the entire set of codes used for drug testing but CMS decided it needed more time to review the changes before pricing the new test codes. CMS developed temporary “G” codes for tests deleted by the editorial panel. CMS is concerned that the changes will result in overpayments, particularly when each individual drug tested is billed rather than one code billed regardless of how many drugs are tested. Laboratory compliance officers should take note of this CMS concern about payments for drug testing.
Information about the CLFS can be found on the CMS website on the laboratory center webpage at http://www.cms.gov/Center/Provider-Type/Clinical-Labs-Center.html
A radical change in the method used to determine laboratory fees will occur beginning in 2015. In the next issue of G2 Compliance Advisor, we will cover the subject of laboratory fees now and in the future in more detail.