Listed below are some of the more significant changes to Medicare reimbursement for clinical laboratory testing that will be brought about by the Protecting Access to Medicare Act of 2014 (PL 113-93), in approximate order of implementation. The act delays cuts in physicians’ Medicare fee rates while making reforms to the CMS Clinical Laboratory Fee Schedule (CLFS)—the first such changes in 30 years. The Congressional Budget Office estimates that the CLFS reforms will reduce Medicare spending by $1 billion between 2014 and 2019, and by $2.5 billion between 2014 and 2024.
- April 1, 2014: Enactment establishes the new category of advanced laboratory diagnostic tests, with special payment and coding rules during the transitional period through December 31, 2016.
- July 1, 2015: CMS is required to establish an expert advisory panel for clinical laboratory testing.
- October 1, 2015: Implementation of the transition from the ICD-9 to the ICD-10 coding system is postponed until this date.
- January 1, 2016: CMS must assign Healthcare Common Procedure Coding System (HCPCS) codes for all FDA authorized and advanced diagnostic laboratory tests, and publicly report their payment rates.
- January 2016: Applicable laboratories must begin reporting their payment rates for covered tests.
- January 2017: Medicare payments for clinical diagnostic laboratory tests under the CLFS will be determined using a market-based payment system. All lab tests will be paid according to this system.
- October 1, 2018: The Government Accountability Office must submit to Congress the results of a study on the implementation of the new payment processes for lab tests.