CMS Updates PAMA Lab Data Reporting FAQ Ahead of July 31 Deadline
The Centers for Medicare & Medicaid Services has released an updated FAQ on Protecting Access to Medicare Act private payer data reporting requirements for hospital outreach laboratories. The deadline is July 31, 2026, for laboratories to report private payer clinical diagnostic laboratory data for services furnished during the first six months of 2025. Reporting must include Healthcare Common Procedure Coding System codes, associated private payer rates, and volume data. CMS has published a guide and additional resources to help hospital outreach laboratories determine their reporting obligations.
Medicaid managed care organizations with laboratory services or carved-in clinical diagnostics may need to verify that contracted hospital outreach laboratories comply with federal PAMA reporting requirements, as non-compliance could affect Medicare payment rates that often serve as benchmarks for Medicaid fee schedules.
Managed Care
You might also like