Medicare Payments for Clinical Diagnostic Laboratory Tests in 2019: Year 2 of the New Fee Schedule 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. The Protecting Access to Medicare Act of 2014 (PAMA) requires CMS to set Medicare payment rates for lab tests using private payer rates collected from labs (PAMA, Pub. L. No. 113-93 § 216(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 under Title XVIII of the Social Security Act (PAMA, § 216(c)(2)(A)). In addition, PAMA mandates that OIG conduct analyses it determines appropriate with respect to the implementation and effect of the new payment system (PAMA, § 216(c)(2)(B)). In accordance with PAMA, we will publicly release an analysis of the top 25 laboratory tests by expenditures for 2019 and analyze the payments made under the new payment system in 2019, the second 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 2020	Centers for Medicare and Medicaid Services	Medicare Payments for Clinical Diagnostic Laboratory Tests in 2019: Year 2 of the New Fee Schedule Rates	Office of Evaluation and Inspections	OEI-09-20-00450	2021