Clinical Labs Center
- New and Reconsidered Clinical Laboratory Fee Schedule (CLFS) Test Codes and Preliminary Payment Determinations for Calendar Year 2013
- New and Reconsidered Clinical Laboratory Fee Schedule Test Codes and Final Payment Determinations
- The CLIA Brochure [PDF, 455KB] is designed to provide education on CLIA test methods categorized, enrollment In the CLIA program, types of certificates, certificate compliance and performance measures, and certificate of accreditation.
- Do you want to find out Medicare Fee-for-Service information quickly? Subscribe to a CMS Electronic Mailing Lists: Keeping Medicare Fee-For-Service Providers Informed [PDF, 410KB] that suits your needs!
- Extension of Reasonable Cost Payment for Clinical Lab Tests Performed by Hospitals with Fewer than 50 Beds in Qualified Rural Areas - On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). Section 3122 of the PPACA re-institutes reasonable cost payment for clinical lab tests performed by hospitals with fewer than 50 beds in qualified rural areas as part of their outpatient services for cost reporting periods beginning on or after July 1, 2010, through June 30, 2011. This could affect services performed as late as June 30, 2012. If you are a hospital who qualifies under Section 3122, you do not need to take any action. You will receive reasonable cost reimbursement for an entire year, starting with your cost reporting period beginning on or after July 1, 2010. Please be on the alert for more information pertaining to the PPACA.
Medicare Learning Network (MLN) Spotlights
Go to the page for the latest MLN products and announcements! Check it often!
Important Links
Billing / Payment
- Clinical Laboratory Fee Schedule
- Electronic Billing & EDI Transactions - Medicare information on electronic transactions under HIPAA
Legislation
Demonstration
Coverage
- Medicare Coverage - General Information
- National Coverage Determinations (NCD) Manual - Pub. 100-03
- Lab NCDs
Policies/Regulations
- Regulations and Notices
- Code of Federal Regulation Citations
- Negotiated Rulemaking: Coverage and Administrative Policies for Clinical Diagnostic Laboratory Services
- Pages 58788-58836 [PDF, 3MB]
- Pages 58837-58886 [PDF, 1MB]
- Pages 58887-58890 [PDF, 424KB]
- Medicare Claims Processing Manual - Chapter 16 - Laboratory Services [PDF, 405KB]
- Chapter 15 – Covered Medical and Other Health Services [PDF, 1MB]
- Quarterly Provider Updates
- Clinical Laboratory Improvement Amendments (CLIA)
- HIPAA - General Information
- Physician Self Referral
Education
Coding
- National Correct Coding Initiative Edits
- Column 1/Column 2 Pathology and Laboratory Services -
- Mutually Exclusive Pathology and Laboratory Services -
- HCPCS - General Information
- Alpha-Numeric HCPCS
- ICD-9-CM
- ICD-10
- The latest HIPAA codes are available at the Washington Publishing Company (WPC) Website.
Program Transmittals
Medicare Secondary Payer
Enrollment/Participation
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- Information for Medicare Fee-for-Service Providers for the National Provider Identifier Standard (NPI)
Contacts
- Quality Improvement Organizations (QIO)
- CMS Regional Offices
- Coordination of Benefits - General Information (COBC)
How to Stay Informed
- End-Stage Renal Disease and Clinical Laboratories Open Door Forum
- CMS Media Release Search