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CodeMap® Compliance Briefing: August 3, 2016


Editor's Welcome: The following CodeMap® Compliance Briefing discusses recent news from the Centers for Medicare & Medicaid Services (CMS) concerning reimbursement amounts for tests and services set via the gap-filling method. As we learned from the last briefing, CMS uses one of two methods to set reimbursement rates for new tests listed on the Medicare Clinical Laboratory Fee Schedule (CLFS); one, cross-walking, where the new test is priced the same as a similar code or codes already on the CLFS; or two, gap-filling, where the individual Medicare Contractors report their payment amounts, and CMS then sets the payment amount as the median. Recently, CMS announced the preliminary gap-filled rates that will becomes effective January 1, 2017. 

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