Sunday, January 1, 2023

Brief Blog: CMS Updates Webpage for Latest PAMA Pricing Rules

CMS has updated its PAMA regulations page based on the December 29, 2022 federal budget bill. 

 There will be no PAMA rate cuts in CY2023, but there will be a three year block of rate cuts that are capped at 15% per year (2024, 2025, 2026).  


The original PAMA legislation for lab pricing envisioned the Period 1 three year fee schedule as 2018, 2019, 2020, with 10% caps on rate cuts.    Then, Period 2 would occur, a three year fee schedule for 2021, 2022, 2023, with 15% cpas on rate cuts.

Congress has set the cap at 0% (no reduction) in 2021, 2022, and now 2023.   However, the "three years of 15% caps" idea is still in the legislation and should now come out of hibernation and occur in 2024, 2025, 2026.   After that, there are no caps on the size of rate cuts in each new PAMA cycle.

CMS updated its web page accordingly.