PAMA Reporting Solutions For Labs

PAMA Reporting for Labs

The Protecting Access to Medicare Act of 2014 (PAMA) revised the payment methodology for clinical diagnostic laboratory tests paid under the Medicare Clinical Laboratory Fee Schedule (CLFS). In accordance with PAMA, CMS will determine the payment rates for the clinical laboratory fee schedule in 2025 based on the rates reported by applicable laboratories from private payers.

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CMS Further Delays PAMA

In November 2023, the Further Continuing Appropriations and Other Extensions Act of 2024 delayed the PAMA data reporting period from 2024 to 2025. Applicable laboratories were given an additional year to report final payment data collected during the first six months of 2019.

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Saving Access to Laboratory Service Act (SALSA)

New bipartisan legislation called the Saving Access to Laboratory Service Act (SALSA) would update Medicare’s payment rates for clinical diagnostic laboratory services by simplifying the data reporting process and providing CMS with the authority to collect data from a statistical sampling of all major types of laboratories that provide services to seniors, including independent, hospital, and physician office laboratories.

This legislation also reduces reporting burdens on labs by changing the required reporting periods from every three years to every four years and sets Medicare reimbursement on a sustainable path, guarding against excessive payment cuts and increases on rates for tests.

In November 2023, Congress included a one-year delay to Medicare reimbursement cuts for clinical laboratory services in the short-term funding bill passed. More than 30 health care provider organizations remain focused on gaining passage of SALSA in 2024.