Skip to Main Content

Clinical Labs Center

  • Temporary Delay in Implementing Ordering and Referring Denial Edits 
    Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed. These edits would have checked the following claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI). If either of these were missing or incorrect, claims would deny.  

    • Medicare Part B claims from laboratories, imaging centers and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and  
    • Part A Home Health Agency (HHA) claims that require an attending physician provider. 

    CMS will advise you of the new implementation date in the near future. In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place. For more information, see the revised article  SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims.

  • New and Reconsidered Clinical Laboratory Fee Schedule (CLFS) Test Codes and Preliminary Payment Determinations for Calendar Year 2013
  • New and Reconsidered Clinical Laboratory Fee Schedule Test Codes and Final Payment Determinations
  • The CLIA Brochure [PDF, 455KB] is designed to provide education on CLIA test methods categorized, enrollment In the CLIA program, types of certificates, certificate compliance and performance measures, and certificate of accreditation.
  • Extension of Reasonable Cost Payment for Clinical Lab Tests Performed by Hospitals with Fewer than 50 Beds in Qualified Rural Areas - On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). Section 3122 of the PPACA re-institutes reasonable cost payment for clinical lab tests performed by hospitals with fewer than 50 beds in qualified rural areas as part of their outpatient services for cost reporting periods beginning on or after July 1, 2010, through June 30, 2011. This could affect services performed as late as June 30, 2012.  If you are a hospital who qualifies under Section 3122, you do not need to take any action. You will receive reasonable cost reimbursement for an entire year, starting with your cost reporting period beginning on or after July 1, 2010.  Please be on the alert for more information pertaining to the PPACA.

  • Medicare FFS e-News Spotlights

Important Links

Billing / Payment

Legislation

Demonstration

Coverage

Policies/Regulations

Education

Coding

Program Transmittals

Medicare Secondary Payer

Enrollment/Participation

Contacts

How to Stay Informed