Clinical Labs Center
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Effective January 1, 2018, Clinical Laboratory Fee Schedule rates will be based on weighted median private payor rates as required by the Protecting Access to Medicare Act (PAMA) of 2014. For more details, including how to prepare, collect and report data, visit PAMA Regulations.
- The CLIA Fact Sheet [PDF, 1MB] 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.
MLN Connects Provider eNews Spotlight
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
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 - ICD-9
- Laboratory National Coverage Determinations (NCDs) Index - Opens in a new window
Policies/Regulations
- CLFS 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, 436KB]
- Chapter 15 – Covered Medical and Other Health Services [PDF, 1MB]
- Quarterly Provider Updates
- Clinical Laboratory Improvement Amendments (CLIA)
- Administrative Simplification Overview
- Social Security Act: 1833(h)(1)(A) - Opens in a new window
- Social Security Act: 1833(h)(5)(A) - Opens in a new window
- Physician Self Referral
Educational Resources
Coding
- National Correct Coding Initiative Edits
- Column 1/Column 2 Pathology and Laboratory Services - ccigrp10.zip - Opens in a new window
- Mutually Exclusive Pathology and Laboratory Services - megrp9.zip - Opens in a new window
- HCPCS - General Information
- Alpha-Numeric HCPCS
- ICD-9-CM and ICD-10
- ICD-10
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Claim Adjustment Reason and Remittance Advice Remark Codes - Opens in a new window
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
- (COBC)
How to Stay Informed
Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- End-Stage Renal Disease and Clinical Laboratories Open Door Forum
- Press Releases - Opens in a new window CMS Media Release Search
