Sunday, December 17, 2017

Very Brief Blog: CMS Published CY2018 Full Final CLFS Fee Schedule

It seems anticlimatic after a hectic year of lab policies, unprecedented volumes of crosswalk decisions, PAMA crises and lawsuits...but in 1H December, CMS published the "final CLFS fee schedule" for CY2018.   It's hereDownload the zip file to access the CLFS Excel spreadsheet.

CMS has modified the format from prior years.  There are no longer 57 pricing localities; there is one national price.   All the prices are listed as effective "20180101," so that indicator will be more interesting as the years go by.   CMS now uses the letters "N" and "L" to indicate National or Local pricing, while all the codes with an "L" for local (gapfill) pricing are listed as 0.00 dollars.   Dollar rates are listed in the format 00072.19, for $72.19.   As always, QW stands for Clia Waived (or Qlia Waived?) tests, which have the same price as the standard price.

For additional details, see Transmittal CR10409 (here).  That PDF lists, for example, the final pricing choices behind every price that was crosswalked in summer 2017.   ("New code 81176 is priced at the same rate as code 81218,"etc etc).   New code prices will behave the same as the target code.  Meaning: If New Code is priced to a $200 target code that stays level at $200 each year under PAMA, so does New Code.  But if New Code is priced to a $200 target code that falls by 10% a year under PAMA rules, so does New Code.  By my count 116 codes were crosswalked (many were codes on the CLFS that had no utilization and thus no PAMA pricing). 

18 codes enter the 2018 local gapfill process, in this table:

18 Codes are Class "L for Local" Gapfill in 2018