As part of the US Centers for Medicare & Medicaid Services’ (CMS) final 2014 Medicare physician fee schedule (PFS) released in November, the CMS has announced a new process for reviewing payment amounts for tests that are part of the Clinical Laboratory Fee Schedule (CLFS). The CLFS sets the price paid by Medicare for clinical diagnostic lab services. The review is intended to allow for adjustments to payment amounts due to changes in a test’s cost based on technological changes, such as genomic testing and laboratory developed tests. Over five years, the CMS will examine all CLSF codes, starting with the oldest codes, and make adjustments. In addition, the public will be allowed to nominate codes for review but must submit cost information. In early 2014, CMS will determine which codes to evaluate in the first phase and will publish a list of the codes and the intended changes in the 2015 PFS notice of proposed rulemaking, which will be released in July 2014.

Source: McDermott, Will & Emery