Clinical Laboratory Fee Schedule (CLFS) private payer data reporting delayed one year

Posted on: 1/17/20

CMS has delayed 2020 private payer data reporting for the Clinical Diagnostic Test Payment System until 2021 for tests that are not advanced diagnostic laboratory tests, as required by recent legislation extending funding for federal programs through fiscal year 2020. Under the legislation, applicable laboratories, including hospital outreach laboratories, that were to report data between Jan. 1 and March 31, 2020, will instead report the data between Jan. 1 and March 31, 2021. Data reporting then will resume on a three-year cycle beginning in 2024.

In addition, CMS may not reduce 2020 payment rates for clinical diagnostic laboratory tests that are not advanced or new tests by more than 10% in 2020 and by more than 15% per year in 2021, 2022 or 2023. Congress also directed MedPAC to study and report within 18 months on the least burdensome data collection process that would lead to a “representative and statistically valid data sample of private market rates from all laboratory segments,” including hospital outreach laboratories. The study will consider the variability of private market rates and the appropriate statistical methods for estimating representative rates.

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See also: SE19006 – Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System.