CMS Releases User Guide, Template for CLFS Data Submission

September 16, 2016
Medicare Web

With the first data reporting period beginning January 1, 2017, for CMS’ revamped Clinical Laboratory Fee Schedule (CLFS), the agency has released a user guide and template to aid providers who are required to submit the data.

MLN® Matters SE1620 contains the user guide, which demonstrates how to enter data in the template and submit it through CMS’ fee-for-service data collection system (FFSDCS). CMS will use the data submitted between January 1-March 31, 2017, to set payment rates beginning January 1, 2018. CMS will require providers to send data from January 1-June 30, 2016.

The agency will require labs that receive at least $12,500 in payments under the CLFS and more than 50% of Medicare revenue from laboratory and/or physician services over the data reporting period to report private payer rates and test volumes for laboratory tests. These thresholds will exclude approximately 95% of physician office laboratories and 55% of independent laboratories from having to report information, along with just about all hospital labs, according to CMS.

The template includes fields for providers to input the following data:

  • HCPCS code
  • National Provider Identifier
  • Payment rate
  • Test name
  • Volume

CMS says the FFDCS is undergoing its final stage of testing and will be accessible in November. For more information, included a fact sheet and frequently asked questions, visit CMS’ CLFS page.