CMS Releases Proposed 2018 CLFS Medicare Reimbursement Rates

September 2017 ~

On September 22, CMS published the preliminary 2018 payment rates for the new private payor rate-based Clinical Laboratory Fee Schedule (CLFS) payment system.

These new Medicare reimbursement rates for lab tests are based on private payor rates (as reported by certain clinical labs to CMS during 2016) are scheduled to be finalized in November and implemented January 1, 2018. Based on these preliminary rates, CMS expects reductions in Medicare reimbursement for lab tests of approximately $670 million in 2018.

Additionally, for new and existing laboratory HCPCS codes for which CMS received no applicable information, CMS has made preliminary determinations of crosswalking or gapfilling to establish a payment rate that will also be implemented on January 1, 2018.

As an aid, CMS has published the following documentation for the new private payor rate-based CLFS payment system and determinations of crosswalking or gapfilling:

  • CY 2018 – Preliminary Private Payor Rate-Based CLFS Payment Rates and Analytics [ZIP(568KB)]
  • CLFS Applicable Information Raw Data File showing all data submitted to CMS under PAMA
  • CY 2018 – Summary of Data Reporting for the CLFS Private Payor Rate-Based Payment System [PDF(153KB)]
  • CY 2018 – Clinical Laboratory Fee Schedule Test Codes Preliminary Determinations for Crosswalking or Gapfilling [PDF(234KB)]

CMS will be accepting public comments on the preliminary determinations until October 23.


Source(s): CMS Summary; CMS; Laboratory Economics, Special Report (2017, September);