CMS implements overall cuts for pathology, independent lab services in 2019 MPFS Final Rule

December 11, 2018

CMS has released the 2019 Medicare Physician Fee Schedule Final Rule and again signaled their intent to cut overall payments for pathology and independent laboratory services.

The agency will institute a 1.3 percent bump for 88305-TC, which will see the payment jump to $30.63, while the code’s global rate will experience just a .1 percent hike to $70.28. Meanwhile, the professional interpretation will see a .8 percent cut — dropping the payment to $39.64 — a move that largely foreshadowed CMS’s decision to slightly cut several professional rates while slightly boosting technical and global components for many major pathology codes.

The most significant cuts will again impact prostate biopsies, with the technical rate for G0416 being hit the hardest by a proposed 18.9 percent cut that will drop the payment to $200.74. Meanwhile, the global rate will also see an 11 percent cut down to $386.34, while the .6 percent reduction for the professional rate will lower the payment to $185.60.

The total scope of the finalized changes will see pathologists’ overall Medicare rates cut by 2 percent, while independent labs technical rates will experience a similar 2 percent reduction in total allowed charges. Rate changes take effect on Jan. 1, 2019. For more information on specific code updates, please refer to the chart below.

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