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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2021

Medicare is the largest payer of clinical laboratory services in the United States. 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 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 the Act, we will publicly release an analysis of the top 25 laboratory tests by expenditures for 2021.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
August 2022 Centers for Medicare and Medicaid Services Medicare Payments for Clinical Diagnostic Laboratory Tests in 2021 Office of Evaluation and Inspections OEI-09-22-00400 2023