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CMS Releases Draft CLFS for 2015 - New Codes for Drugs of Abuse Testing

Date: June 9, 2014
Source: CMS



The Public Meeting for new Clinical Laboratory Fee Schedule services will take place on Monday, July 14, 2014. We will accept public comments from that meeting for approximately 1 week. Then, we will determine the basis of payment (either crosswalk or gap-fill) and we will post the preliminary determinations on our web site in early September, 2014. We will accept additional comments from these preliminary determinations through early October, 2014. The basis of payment and the amount of payment will become final at the same time that we issue the annual CMS instruction for CY 2015 (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 crosswalk test, the payment amount for a gap-fill 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.

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