by Jared Staheli
July 9th, 2015
Under Part B, for services rendered on or after July 1, 1984, clinical laboratory tests performed in a physician’s office, by an independent laboratory, or by a hospital laboratory for its outpatients are reimbursed on the basis of fee schedules. Current exceptions to this rule are CAH laboratory services as described in §10, and services provided by hospitals in the State of Maryland.
Medicare pays the lesser of:
• Actual charges;
• The fee schedule amount for the State or a local geographic area; or
• A national limitation amount (NLA) for the HCPCS code as provided by §1834(h) of the Act.
Annually, CMS furnishes to carriers and FIs the proper amount to pay for each HCPCS code for each local geographic area. This includes a calculation of whether a national limitation amount or the local fee schedule amount is to be used.
This information is available to the public on the CMS Web site in public use files.