Access to Clinical Diagnostic Lab Fee Schedule Files

40.1 - Access to Clinical Diagnostic Lab Fee Schedule Files (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) The annual laboratory fee schedule data file should be retrieved electronically through CMS’ mainframe telecommunications system. For each test code, if the MAC’s system retains only the pricing amount, they should load the data from the field named “60% Pricing Amt.” For each test code, if the MAC’s system has been developed to retain the local fee and the NLA, they may load the data from the fields named “60% Local Fee Amt” and “60% Natl Limit Amt” to use to determine payment. For clinical laboratory test codes for cervical or vaginal smear tests (listed in Chapter 16, “Laboratory Services from Independent Labs, Physicians, and Providers,” §80.3) load the data from the field named “60% Pricing Amt” to reflect the lower of the local fee or the NLA, but not less than the national minimum payment amount. The fields named “62% Local Fee Amt,” “62% Natl Limit Amt,” and “62% Pricing Amt” should be used by A/B MACs (A) for payment of clinical laboratory tests performed by a sole community hospital’s qualified laboratory. The annual laboratory fee schedule data is available via the CMS website. It is available in multiple formats: Excel, text, and comma delimited.