Medicare Payments for Clinical Diagnostic Laboratory Tests in 2023

Medicare is the largest payer of clinical diagnostic laboratory services in the United States. Medicare Part B covers most lab tests and pays 100 percent of allowable charges without patient cost-sharing obligation. The Protecting Access to Medicare Act of 2014 (PAMA), Pub. L. No. 113-93, 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 (PAMA, § 216(a)). On January 1, 2018, CMS began paying for lab tests under a new system mandated by PAMA. PAMA also requires OIG to publicly release an annual analysis of the top 25 laboratory tests by expenditure. (Pub. L. No. 113-93 § 216(c)(2)(A)). In accordance with PAMA, we will publicly release an analysis of the top 25 laboratory tests by expenditure for 2023.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
July 2024	Centers for Medicare and Medicaid Services	Medicare Payments for Clinical Diagnostic Laboratory Tests in 2023	Office of Evaluation and Inspections	OEI-09-24-00350	2025