Friday, October 16, 2020

Very, Very Nerdy Note: CMS Again Updates Proposed CLFS Prices for CY2021 (V4)


CMS holds public meetings each summer to price 100+ new lab codes for the coming calendar year.  CMS released proposed prices about September 22 with a comment period to October 21.   CMS has slightly updated this spreadsheet several times, most recently to "Version 4."  

If you want to be completely up to date, go to the CMS lab page here and look for Payment Determinations header and then for the zip file for CY 2021 - Clinical Laboratory Fee Schedule Test Codes Preliminary Payment Determinations (ver. 4) (ZIP).

Or Ver 5, if there is one....Tab B provides edits or corrections, there are now about 12, for example, code 81XX1 was granted ADLT status so it's being removed from the crosswalk decisions.

For example, there was a series of codes where public comment AND panel recommended crosswalk to 81315, but the CMS initial recommendation was to crosswalk the set of codes successively to 81315, then 81316, then 81317, then 81318.  It's now corrected so each crosswalk to the same and correct code 81315.