Data Reporting Requirements for Clinical Laboratory Fee Schedule Delayed One Year

In accordance with recent legislation, the Centers for Medicare & Medicaid Services (CMS) has delayed data reporting for clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests for one year. Applicable laboratories, including hospital outreach laboratories, that had been required to report data between Jan. 1 and March 31, 2020, should now report the data between Jan. 1 and March 31, 2021.

The Protecting Access to Medicare Act requires these laboratories to report private payer rate data for the collection period Jan. 1 through June 30, 2019. The CMS will use this data to determine 2022 clinical laboratory fee schedule (CLFS) payment rates.

The CMS is expected to publish 2022 preliminary CLFS rates in early September 2021. It will provide a 30-day comment period prior to releasing final rates in early November 2021 for the Jan. 1, 2022, effective date. Data reporting will then resume on a three-year cycle in 2024.  

Additional information is available online for Medicare Part B clinical laboratories that submit Medicare claims through Medicare Administrative Contractors. Members with questions should contact Vickie Kunz at the MHA.