- The CMS announcement is here. (82 FR 43239, 9/14/2017).
- For further updates between now and the meeting, HERE (Sept 20).
PAMA section 216 re-calibrates the Clinical Laboratory Fee Schedule (CLFS) by applying new prices that are the medians of market prices determined by a survey of private payer payments (data must be turned over by labs.) In rulemaking last summer, CMS determined that codes with no data would go into a crosswalk-gapfill process. However, CMS tells us that it is now confronted with some 60 CPT codes with either no data, or "too little data" to establish a price. (Sic.) In the July 31/August 1 summer lab policy meetings, CMS proposed it may just delete such codes from the CLFS. Stakeholders responded that CMS had no such authority: There was no legal definition of "too little data" and CMS had already stated by rulemaking that unpriced codes would be handled by crosswalk/gapfill. (CMS admits it already has a regulation to follow: at 42 CFR 414.508(b)(1-2).) (E.g. see letter from AMP to CMS, here.)
CMS states that detailed agenda will be posted about a week ahead of the September 25 workshop. Presentations must be submitted to CMS by September 21 at 5 pm ET.