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Lab Sector Vs. CMS Battle Heats Up As Medicare Agency Moves Forward With 2018 Rates

 
• By David Filmore

Test-makers and labs say the agency is missing large swaths of the market in making its "market-based" lab payment calculation, but CMS stands by its data, and finalized 2018 lab fee schedule rates. Could next steps be in Congress, or the courts?

Medicare, Health Concept

The US Centers for Medicare and Medicaid Services made some tweaks from earlier proposals, but moved ahead with finalizing 2018 payment rates for diagnostic test services that a key lab industry group calls "fundamentally flawed."

Some Firms Happy

While industry groups are crying foul, some individual advanced molecular diagnostic companies that came away with reimbursement increases are expressing satisfaction with CMS' newly finalized rates for 2018.

One of those firms is CareDx Inc., which makes the AlloMap molecular diagnostic for helping to identify the risk of acute cellular rejection in heart transplant recipients. CMS set the AlloMap reimbursement rate for 2018 at $3,240, a 14% increase from 2017. “The implementation of PAMA by CMS provides a refreshing predictability to the reimbursement of diagnostic tests,” said Sasha King, chief commercial officer at CareDx. “The updated rate highlights the value AlloMap brings to heart transplant patients.”

Aspira Labs, a subsidiary of laboratory diagnostics firm Vermillion Inc

About 75% of test codes will see payment reductions, while about 10% will see increases, according to the final 2018 Medicare clinical laboratory fee schedule (CLFS) that CMS posted Nov. 17

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