Medicare Payments for Clinical Diagnostic Laboratory Tests in 2022
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. Under Title XVIII of the Social Security Act (Pub. L. No. 113-93 § 216(c)(2)(A)), 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. On January 1, 2018, CMS began paying for lab tests under a new system that calculates payment rates using private payor rates mandated by PAMA. PAMA also mandates that OIG publicly release an annual analysis of the top 25 tests based on Medicare Part B spending and that it conduct analyses that OIG determines appropriate. OIG will analyze and report on the top 25 laboratory tests by expenditure for 2022.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|June 2023||Centers for Medicare and Medicaid Services||Medicare Payments for Clinical Diagnostic Laboratory Tests in 2022||Office of Evaluation and Inspections||OEI-09-23-00350||2024|