Tuesday, May 10, 2022

Very Brief Blog: CMS Posts CLFS Update, New Codes, Reprises PAMA Years

CMS issues the Clin Lab Fee Schedule (CLFS) update for July 1, 2022, with cover date May 4, 2022.


CMS adds 9 new PLA Codes for July 1, 0323U-0331U.  These are codes that were announced by AMA CPT on about April 1.   (CMS also mentions deletions of 0139U, 0168U).  Note that the newest batch of PLA codes are voted on this week at AMA CPT and will be released by AMA on July 1, but, will probably also be released by CMS by early June to be part of the June annual pricing meeting.    

CMS also reprises info on PAMA timelines.

The next data reporting will be 1Q2023, reporting claims data from 1H2019.  This will result in a new fee schedule CY2024 2025 2026.   Labs will report 2025 data in 2026 to make a new three year fee schedule CY2027 2028 2029.

CMS notes there is 0 price reduction in 2021 2022, and a max price reduction per year of 15% in CY2023-2024-2025.   

After that (e.g. 2026 or for the new years 27-28-29) there is no annual cap on the price reduction, it is based only on survey data with an immediate price reset.