Medicare Part B CLFS: Revised Information for Laboratories on Collecting & Reporting Data for the Private Payor Rate-Based Payment System

MLN Matters Number: SE19006 Revised
Article Release Date: December 4, 2023

Note: CMS revised this Article to note that for CDLTs that aren’t ADLTs, the data reporting period is delayed and resumes starting January 1, 2025 - March 31, 2025. Also, CMS extended the 0% limit on laboratory payment reductions to the end of CY 2024 and the 15% limit on payment reductions per year to CY 2025 - 2027 (see pages 2, 14, 15, and 20-24).

SE 19006 tells you about:

  • Clarifications for deciding whether a hospital outreach laboratory meets the requirements to be an "applicable laboratory"
  • Applicable information (private payor rate data) that you must collect and report to CMS
  • The entity responsible for reporting applicable information to CMS
  • The data collection and reporting periods
  • Information about our online data collection system
  • CMS schedule for implementing the next private payor-rate based Clinical Laboratory Fee Schedule (CLFS) update
  • Information about the condensed data reporting option for reporting entities

Make sure your billing staff knows about these changes.

View the complete CMS Special Edition (SE)19006.

Last Updated Dec 14 , 2023