Reimbursement and Coverage

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP),…

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP), as well as commercial plans.

Lab reimbursement in many of these programs has been reduced in recent years, and in the case of the Medicare program, annual cuts are scheduled in current law not only as a result of sequestration, but also through annual cuts built into the Affordable Care Act.

While payments for lab services are being slashed, the costs associated with providing critical laboratory services - including labor, supplies, and transportation - continue to climb.

Although many labs have managed to navigate changes in markets and reimbursement and while still continually improving quality, continued arbitrary and severe payment reductions will result in reduced access to essential tests for critically ill patients, less innovation, more closures or consolidation of businesses, and more people out of jobs.

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  • Letter to CMS Regarding Gap Fill

    April 30, 2013
      Marilyn B. Tavenner Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services 200 Independence Ave., SW Washington, DC 20201 Dear Administrator Tavenner: We are a coalition of patients, providers, clinical laboratories, diagnostic test manufacturers, pharmaceutical companies, and venture capital investors unified in our concern over interim 2013 Medicare Administrative Contractor (MAC) reimbursement rates for molecular diagnostic testing. ThisContinue Reading »...
  • Letter to Sens Baucus and Hatch Regarding Clinical Laboratory Fee Schedule

    April 16, 2013
      The Honorable Max Baucus Chairman, Committee on Finance United States Senate 219 Dirksen Senate Office Building Washington, DC 20510 The Honorable Orrin Hatch Ranking Member, Committee on Finance United States Senate 219 Dirksen Senate Office Building Washington, DC 20510 Dear Chairman Baucus and Ranking Member Hatch: On behalf of the undersigned organizations—representing America’s community, regional, hospital-based, and national clinical laboratories; the laboratory professionalsContinue Reading »...
  • ACLA Opposes Further Cuts To Clinical Laboratories In President’s 2014 Budget – Proposal Would Cut Lab Reimbursement By An Additional 14% Over Ten Years

    April 10, 2013
    (Washington, DC) – The American Clinical Laboratory Association (ACLA) strongly opposes a proposal in the President’s 2014 budget that would reduce reimbursement for clinical laboratory services in Medicare by an additional $9.460 billion over ten years, a cut of at least 14% over ten years. This proposal, on top of the cuts already scheduled under current law, would bring total cuts to the ClinicalContinue Reading »...
  • Letter Regarding Gapfilling for Molecular Pathology Tests

    March 27, 2013
      Mr. Marc Hartstein Director, Hospital and Ambulatory Policy Group Centers for Medicare and Medicaid Services Mail Stop C4-01-26 7500 Security Boulevard Baltimore, MD 21244 RE: Gapfilling for Molecular Pathology Tests Dear Marc: I am writing on behalf of ACLA to follow-up on our prior conversations regarding the gapfilling process for new molecular pathology codes, which CMS has mandated. As you know, in theContinue Reading »...
  • CLC Letter to Sen Baucus Regarding Clinical Lab Fee Schedule

    February 15, 2013
      February 15, 2012 The Honorable Max Baucus United States Senate 511 Hart Senate Office Building Washington, DC 20510 Dear Senator Baucus: The undersigned laboratory and health care organizations, representing America’s community, regional, and national laboratories and the Medicare patients we serve, ask that you oppose any cuts to the Medicare Part B Clinical Laboratory Fee Schedule as you work to address physician payContinue Reading »...
  • Comments on PFS Final Rule for CY 2013

    December 21, 2012
        December 21, 2012   Ms. Marilyn Tavenner, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attn: CMS-1590-FC P.O. Box 8013 Baltimore, Maryland 21244-8013   Dear Ms. Tavenner:   The American Clinical Laboratory Association (“ACLA”) appreciates the opportunity to comment on the “Medicare Program; Revision of Payment Policies Under the Physician Fee Schedule for CY 2013, FinalContinue Reading »...
  • ACLA Applauds Enactment of Bill Increasing Flexibility of Regulations that Threaten Access to Clinical Lab Tests

    December 04, 2012
    For Release: December 4, 2012 Contact: Jason DuBois, 202-637-9466 ACLA Applauds Enactment of Bill Increasing Flexibility of Regulations that Threaten Access to Clinical Lab Tests WASHINGTON, DC — The American Clinical Laboratory Association (ACLA) today applauded President Barack Obama for signing into law the Taking Essential Steps for Testing Act (TEST Act), introduced in the House by Rep. Michael Grimm (R-NY) and in theContinue Reading »...
  • Letter to CMS Regarding Gapfilling

    November 30, 2012
    November 30, 2012   Marilyn Tavenner, Acting Administrator Centers for Medicare and Medicaid Service 7500 Security Boulevard Baltimore, Maryland 21244   Dear Ms. Tavenner: On behalf of the American Clinical Laboratory Association (“ACLA”), I am writing to express our serious concerns about the Centers for Medicare and Medicaid Services’ (“CMS’s” or “the agency’s”) intention to direct the Medicare Administrative Contractors (“MACs”) to use gapfillingContinue Reading »...
  • ACLA Lauds Senate Approval of Bill Increasing Flexibility of Regulations that Threaten Access to Clinical Lab Tests

    November 15, 2012
    For Release: November 15, 2012 Contact: Jason Dubois, 202-637-9466 ACLA Lauds Senate Approval of Bill Increasing Flexibility of Regulations that Threaten Access to Clinical Lab Tests WASHINGTON, DC — The American Clinical Laboratory Association (ACLA) today applauded the U.S. Senate for yesterday’s passage of the Taking Essential Steps for Testing Act (TEST Act), introduced in the House by Rep. Michael Grimm (R-NY). The HouseContinue Reading »...
  • ACLA Applauds CMS’ Decision on Medicare Payment for Molecular Diagnostic Laboratory Tests; Has Serious Concerns About Drastic Cuts to Pathology Services

    November 02, 2012
    November 2, 2012 For Immediate Release Contact: Alan Mertz, 202-637-9466 ACLA Applauds CMS’ Decision on Medicare Payment for Molecular Diagnostic Laboratory Tests; Has Serious Concerns About Drastic Cuts to Pathology Services Washington, DC. The American Clinical Laboratory Association (ACLA) applauds the release yesterday of a final decision by the Centers for Medicare and Medicaid Services (CMS) regarding Medicare payment for molecular diagnostic tests performedContinue Reading »...
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