Laboratory Public Meetings

The Public Meeting for new and reconsidered Clinical Laboratory Fee Schedule services occurred on July 16, 2012.  We accepted public comments from that meeting for approximately 1 week.  Then, we determined the basis of payment (either crosswalked or gap-filled) and we posted the preliminary determinations on our web site on August 31, 2012.  We are accepting additional comments from these preliminary determinations through September 28, 2012.  The basis of payment and the amount of payment become final at the same time that we issue the annual CMS instruction for CY 2013 (approximately early November).  Then, the public has 60 days from the date we issue our annual instruction to request reconsideration of either the basis of payment or the amount of payment for these new test codes.  And, the public may comment on any reconsideration requests at the next Annual Public Meeting.  In addition, for any new test code that will be gap-filled, we ask our Medicare contractors to develop carrier-specific gap-filled amounts by April 1 of the following year.  These amounts will then be finalized on September 30 of that year.  Unlike a crosswalked test, the payment amount for a gap-filled test is not established when we determine the basis for payment because it takes approximately 9 months for our contractors to establish carrier-specific amounts.  After these prices are developed by the Medicare contractors, we will post them on our web site and accept comments for 60 days after April 1 (not reconsideration requests, just comments).  Later in the year, when the gap-filled payment amounts are posted on the web site as final, we will accept reconsideration requests on the gap-filled payment amounts for 30 days.  Once the reconsideration process is completed for a cycle, the determination is final and would not be subject to further reconsideration.