New Methodology Rate Adjustments on CA Medi-Cal Laboratory Fees

In accordance with CA Assembly Bill (AB) 1494 and as an ongoing effort by the Department of Health Care Services (DHCS) to develop new payment rates in order to cut down expenditures, DHCS has requested/solicited payment data from laboratory providers that represents 80% of the provider’s payments. DHCS utilized the data collected to develop a new Payment Rate Methodology which became effective in July, 2016. There are approximately 240 Codes affected by the new Methodology Rate. The new rates for specific codes (CPT) are posted on the DHCS Clinical Laboratories and Laboratory Services Rate Methodology Change website: http://www.dhcs.ca.gov/provgovpart/Pages/CLLS.aspx

Some of the Anatomic Pathology (AP) codes affected by the new rates are as follows:

(Note: there were no changes made for CPT codes 88302/88307 and 88309)

In summary, the rate change (payment reduction) will affect the Global fee, but obviously the fixed percentage for Professional Component (PC) would not change but likely the amount paid overall will be lower. It is important to mention that if there was no payment data submitted (i.e. special stains and Paps) on a specific code (CPT), DHCS didn’t change the price and it will not be included on the New Methodology Rates by Code list.  Any questions or comments regarding the 2016 new methodology rates can be submitted to the DHCS Clinical Laboratory email box: labcomments@dhcs.ca.gov

To view all of the laboratory rates:
http://files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp

The California Society of Pathologists (CSP) is continuing to work with DHCS and is looking to establish a small workgroup or committee to focus on Practice Management issues. APS Medical Billing will continue to monitor and provide updates as they become available.