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Ibex often gets questions about which locality or which Medicare region (MAC) has the best reimbursement rates.  Even a number of years ago some labs sought to locate in favorable reimbursement locations in order to maximize their reimbursement.  None of that matters any longer. 

Under changes required by the law Protecting Access to Medicare Act of 2014, also known as PAMA, the separate fee schedules or modifications by location have been eliminated.  The 57 localities eliminated and there is now one national price for all CPTs for laboratory billing.  PAMA was originally signed into law in 2014, delayed to 2015, and major provisions that have wide-reaching implications for laboratory billing went into effect Jan 1, 2018.

Here is what the 2017 Medicare clinical diagnostic laboratory fee schedule looked like:

Screenshot of 2018 Medicare Laboratory Fee Schedule (MLFS)-1

*(with columns going far off to the right for every locality in the country)

vs the 2018 Medicare clinical diagnostic laboratory fee schedule where you will see there are no longer any variances by locality:

2018 Clinical Diagnostic Laboratory Fee Schedule  
CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
0001M 20180101N00072.19Infectious dis hcv 6 assays
0001U 20180101L00000.00Rbc dna hea 35 ag 11 bld grp
0002M 20180101N00503.40Liver dis 10 assays w/ash
0002U 20180101L00000.00Onc clrct 3 ur metab alg plp
0003M 20180101N00503.40Liver dis 10 assays w/nash
0003U 20180101N00950.00Onc ovar 5 prtn ser alg scor
0004M 20180101L00000.00Scoliosis dna alys
0005U 20180101N00760.00Onco prst8 3 gene ur alg
0006M 20180101L00000.00Onc hep gene risk classifier
0006U 20180101N00246.92Rx mntr 120+ drugs & sbsts
0007M 20180101L00000.00Onc gastro 51 gene nomogram
0007U 20180101N00114.43Rx test prsmv ur w/def conf
0008U 20180101N00597.91Hpylori detcj abx rstnc dna
0009M 20180101L00000.00Fetal aneuploidy trisom risk
0009U 20180101L00000.00Onc brst ca erbb2 amp/nonamp
0010U 20180101L00000.00Nfct ds strn typ whl gen seq
0011U 20180101N00114.43Rx mntr lc-ms/ms oral fluid
0012U 20180101L00000.00Germln do gene reargmt detcj
0013U 20180101L00000.00Onc sld org neo gene reargmt
0014U 20180101L00000.00Hem hmtlmf neo gene reargmt
0016U 20180101N00202.42Onc hmtlmf neo rna bcr/abl1
0017U 20180101N00113.17Onc hmtlmf neo jak2 mut dna
36415 20180101N00003.00Routine venipuncture
78267 20180101N00011.06Breath tst attain/anal c-14
78268 20180101N00094.41Breath test analysis c-14
80047 20180101N00013.73Metabolic panel ionized ca
80047QW20180101N00013.73Metabolic panel ionized ca
80048 20180101N00010.44Metabolic panel total ca
80048QW20180101N00010.44Metabolic panel total ca
80051 20180101N00008.66Electrolyte panel
80051QW20180101N00008.66Electrolyte panel
80053 20180101N00013.04Comprehen metabolic panel
80053QW20180101N00013.04Comprehen metabolic panel
80055 20180101N00059.02Obstetric panel
80061 20180101N00016.53Lipid panel 
80061QW20180101N00016.53Lipid panel 

*(only showing first few lines)

The full Medicare Laboratory Fee Schedule for 2018 can be found here:

2018 Medicare Laboratory Fee Schedule

About Ibex Laboratory RCM

Ibex Billing is a laboratory revenue cycle management (RCM) company.  We only do laboratory and pathology billing. Ibex‘s management team has hundreds of years of revenue cycle management experience. Lab billing is different than physician billing and we only do laboratory revenue cycle management.

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