CLFS and Lab Services Annual Update

In with the new and out with the old … codes, that is.  Jan. 1 means many codes have been added, revised, or removed to and from the Clinical Laboratory Fee Schedule (CLFS).  The New Year also means new rates.

Payment Update

The 2010 annual update to the local clinical lab fees is -1.4 percent; however, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) adjusts the annual update by -0.5 percent through 2013. This makes the annual update to CLFS payments actually -1.9 percent. The annual update to payments made on a reasonable charge basis for all other lab services for 2010 is zero percent.

The 2010 national minimum payment amount is $15.13 ($15.42 plus -1.9 percent). The affected codes for the national minimum payment amount are 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88164, 88165, 88166, 88167, 88174, 88175, G0123, G0143, G0144, G0145, G0147, G0148, and P3000.

Pricing Information

Effective for dates of service on or after Jan. 1, the laboratory travel code P9603 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually traveled fee is $1 per mile; for code P9604 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated miles actually traveled, the fee is $10 per flat rate trip.

The 2010 CLFS includes separately payable fees for certain specimen collection methods (codes 36415, P9612, and P9615). You can access the 2010 CLFS file on the Centers for Medicare & Medicaid Services (CMS) Web site.

Expiration of Moratorium

Jan. 1 also marks the date that independent labs may no longer bill Medicare for the technical component (TC) of physician pathology services furnished to patients of a hospital, regardless of patient hospitalization status (inpatient/outpatient).

Read CMS Transmittal 1884, CR 6657 for complete details as well as mapping information for clinical laboratory test codes.

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