Medicare Laboratory Payment Policy:

Medicare Laboratory Payment Policy:

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Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.Four laboratory tests in our sample, Current Procedural Terminology (CPT) codes 88164, 88305, 88307, and 88342, are classified as anatomic pathology or surgical pathology codes in the American Medical Association (AMA) CPT manual.

Title:Medicare Laboratory Payment Policy:
Author:Committee on Medicare Payment Methodology for Clinical Laboratory Services, Institute of Medicine, Division of Health Care Services
Publisher:National Academies Press - 2000-12-04


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