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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2018: Year 1 of New Payment Rates

Medicare is the largest payer of clinical laboratory services in the Nation. Medicare Part B covers most lab tests and pays 100 percent of allowable charges, with no beneficiary copayment. In 2017, Medicare paid $7.1 billion for lab tests, a total that has changed very little in the 4-year period from 2014 through 2017. The Protecting Access to Medicare Act of 2014 (PAMA) requires CMS to set payment rates for lab tests using current charges in the private health-care market, under Title XVIII of the Social Security Act. (Pub. L. No. 113-93 § 216(c)(2)(A)). On January 1, 2018, CMS began paying for lab tests under the new system mandated by PAMA. PAMA requires OIG to publicly release an annual analysis of the top 25 laboratory tests by expenditures. In accordance with PAMA, we will publicly release an analysis of the top 25 laboratory tests by expenditures for 2018, the first year of payments made under the new system for setting payment rates.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
June 2019 Centers for Medicare & Medicaid Services Medicare Payments for Clinical Diagnostic Laboratory Tests in 2018: Year 1 of New Payment Rates Office of Evaluation and Inspections OEI-09-18-00100 2020