Medicare Will Use Private Payer Prices To Set Payment Rates for Lab Tests Starting In 2018

Medicare is collecting private payer data on payments for clinical diagnostic laboratory tests (CDLTs) to establish new Medicare rates starting January 1, 2018. The rate for any given CLDT will be the weighted median of the private payer rates for the test. However, during the first three years of the new methodology, no rates will be cut by more than 10% in a given year, even if the weighted median private payer rate is lower by a greater percentage.

The new methodology for clinical test rates is required by the Protecting Access to Medicare Act of 2014 (PAMA). The PAMA . . .