What’s happening: The Continuing Appropriations and Extensions Act of 2025, passed at the end of September, has delayed the clinical laboratory fee schedule private payer reporting requirements for hospital outreach laboratories.
What else to know: The next data reporting period is from Jan. 1, 2025, to March 31, 2026.
Data reporting is based on the original collection period from Jan. 1, 2019, to June 30, 2019. Hospital outreach laboratories that billed more than $12,500 via the Form CMS-1450 14x Type of Bill during the data collection period will be required to report private payer payment data.
The Continuing Appropriations and Extensions Act also extended the phase-in of payment reductions resulting from private payer rate implementation:
- There are no payment reductions for calendar year 2025.
- Payment won’t be reduced by more than 15% for calendar year 2026–2028 compared to the payment amount established for a test the preceding year.