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CMS Plan for Test Pricing Seems to Favor Large Labs

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CMS has finally released its plan for market-based reimbursement of lab testing, and early reaction from industry seems to be that large test providers such as Quest and LabCorp will benefit most from the new system.

The new system requires that “applicable laboratories” report to CMS rates from private payers for lab tests and the volumes of tests reimbursed over various periods. CMS will then use this information to calculate a weighted median payment amount for each test.

Only large, high volume reference labs seem to qualify as “applicable laboratories” under the definition. Do to their lower costs structures these labs could push reimbursement rates down, potentially to the detriment of smaller labs and hospitals.

Stakeholders have until Nov. 24 to comment on this proposal.