Clinical Laboratory Fee Schedule
Each year the ASM presents recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding payment levels for new tests and fee schedule changes. The statements are listed below in chronological order:
The Centers for Medicare and Medicaid Services (CMS) defines the "cross walking" payment methodology in the June 29, 2001 Federal Register Notice [HCFA-1186-N] as follows: "We determine a new test to be similar to an existing test, multiple existing test codes or a portion of an existing test code. The new test code is then assigned the related existing local fee schedule amounts and resulting national limitation amount. In some instances, we determine that a test may only equate to a portion of an existing test, and, in those instances, we specify payment at an appropriate percentage of the payment for the existing test."
CMS defines "gap filling" payment methodology in the June 29, 2001 Federal Register Notice [HCFA-1186-N] as follows: "Gap filling is used when no comparable, existing test is available. We then instruct each Medicare carrier to determine a payment amount for its area for use in the first year. Then, we take the carrier-specific amounts to establish a national limitation amount for the following year."