Clinical Laboratory Fee Schedule

What’s the CLFS?

We pay for most clinical diagnostic laboratory tests (CDLTs) based off the weighted median of private payor rates (fee schedule). Typically, we update the payment rates using private payor rates every 3 years. This is based on The Protecting Access to Medicare Act (PAMA).

These amounts are based on information laboratories submit during a data collection period. There are 3 steps in the process:

1. Collect data (data collection period): Laboratories submit applicable information.
2. Analyze data (reviewing window): Laboratories and their reporting entities determine whether they meet the majority of Medicare revenues and low expenditure thresholds. Be sure to review and validate applicable information before you report it.
3. Report data (data reporting period): Reporting entities report applicable information to us. The next data reporting period is January 1–March 31, 2024. Learn more about reporting data.

What’s a private payor?

These are private payors:

• A health insurance issuer
• A group health plan
• A Medicare Advantage Plan
• A Medicaid Managed Care Organization

What happens next?

After the next data reporting period, there’s a 3-year data reporting cycle for CDLT. We update the rates under the CLFS every 3 years.

When are the rates effective?

We’ve extended the statutory phase-in of payment reductions resulting from implementing the private payor rate.

Contact us

• Information on final rules: CLFS_Inquiries@cms.hhs.gov
• Information on the data collection system: clfshelpdesk@dcca.com

For more information

• View the CLFS files
• View the Summary of Private Payor Rate-Based Medicare Clinical Laboratory Fee Schedule (PDF)
• View the CLFS Applicable Raw Data File (from 2017 reporting)
• View the CLFS Applicable Information HCPCS Codes (ZIP)
• Visit the Clinical Labs Center for more clinical laboratory provider and supplier information