Late Year Relief for Clinical Laboratories

January 12, 2023

The end of 2022 brought some late year relief for clinical laboratories in the form of the Consolidated Appropriations Act, 2023. The end of year spending package made 2 key changes that affect current and future reimbursement by Medicare to clinical laboratories. The Act:

1.    Revised the next data reporting period required by the Protecting Access to Medicare Act (PAMA) for 1 year.
2.    Delayed the statutory phase-in of payment reduction resulting from private payer rates reported in the first period required by PAMA for 1 year.

This is great news for clinical laboratories around the nation, as PAMA allows for cuts of up to 15% to any HCPCS code the CMS identifies as overpriced based off PAMA data reporting. Instead, all services will see a 0% reduction based off the delay. This does fall short of legislation that was not advanced in late 2022, Saving Access to Laboratory Services (SALSA), which aimed for a 4 year data reporting cycle and much lower reductions (5% at most) to any HCPCS code payment rate than the 15% that PAMA allows. The below PDF contains a chart that outlines the updated data collection period, data reporting period and reduction caps based off the date of service for claims since PAMA was enacted.

APS will take this good news for now, but hope for continued review of the PAMA requirements as a whole.