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Clinical Laboratory

News
Modified: 4/10/2024
This article is for clinical laboratories who submit claims for services paid under the Medicare Part B clinical laboratory fee schedule (CLFS) to Medicare administrative contractors (MACs) for services furnished to Medicare beneficiaries. This article was revised January 8, 2020, to note that for CDLTs that are not ADLTs, the data reporting is delayed by one year and must now be reported from January - March 2021 (previously January - March 2020). All references to the 2020 data reporting period have been changed to 2021. The “CLFS Data Reporting Period Delayed” section was revised to summarize the changes. All other information remains the same. [SE19006]
More
LCD / NCD – policy information
Search for clinical laboratory-related LCDs using these available resources:
View First Coast’s active / proposed LCDs / articles on CMS’ Medicare coverage database (MCD) external link
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
More
Education
Utilize educational information from First Coast and CMS on clinical laboratory services.
list item Search for CMS upcoming events external link
list item CMS open door forums external link -- CMS sponsors regularly scheduled “Open Door Forums" providing an opportunity for live dialogue between CMS and the stakeholder community at large.
CMS Internet-only manual (IOM)
The CMS IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives.
The following CMS manual contains information specific to clinical laboratory providers:
list item Medicare Claims Processing Manual, Chapter 16 - Laboratory services external pdf file for specific information related to this specialty.
list item Medicare Benefit Policy Manual, Chapter 15, Sec.80.1 external pdf file, for specific information related to covered medical and other health services.
Resources
Listed below are additional resources identified specifically for clinical laboratory services.
list item CMS Clinical labs center external link (Spotlights, etc.)
list item Clinical laboratory fee schedule external link (fee schedule, regulations, notices, public meetings, code of federal regulations, transmittals)
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.