Reduced UDT Rates Proposed by CMS

-->October 6, 2017Billing & Compliance Alerts


Dear Valued Clients:

 As communicated in a recent update from prominent Healthcare Attorney *David Vaughn, ESQ, “on September 22, 2017, CMS released a proposed material reduction to the Clinical Laboratory Fee Schedule (“CLFS”), affecting urine drug tests (“UDT”) based on the information it received from lab reporting under the Protecting Access to Medicare Act (“PAMA”).

The proposed CLFS reductions contemplate six years of reductions to the UDT codes, G0480-G0483.  Rates will decrease no more than 10% per year for the first 3 years, and no more than 15% per year for the next 3 years.

The proposed CLFS payments over the next three years for the four Medicare UDT G codes are as follows, which effectuate a 10% reduction per year:

G0480  2017 ($117.65); 2018 ($105.89); 2019 ($95.30); 2020 ($85.77)

G0481  2017 ($160.99); 2018 ($144.89); 2019 ($130.40); 2020 ($117.36)

G0482  2017 ($204.34); 2018 ($183.91); 2019 ($165.52); 2020 ($148.96)

G0483  2017 ($253.87); 2018 ($228.48); 2019 ($205.63); 2020 ($193.71)

The final decision on the proposed rates will be promulgated in early November of this year, with the effective date to be January 1, 2018.”

*I wish to thank Attorney David Vaughn for the content of this alert.  David Vaughn, ESQ – of Vaughn & Associates, LLC – is a prominent Healthcare Attorney specializing in anesthesia and pain management compliance, with practice headquartered in Baton Rouge, Louisiana.

Bellinger P. Moody, RHIA, CPC-I, CPC, CCP