Question:
Under PAMA regulations, how is pricing determined for new laboratory test codes that do not yet have established Medicare payment rates?
Answer:
PAMA regulations instruct the MACs to establish local payment amounts for new laboratory test codes using the following sources of information, if available: Charges for the test and routine discounts to charges Resources required to perform the test Payment amounts determined by other payors Charges, payment amounts, and resources required for other tests that may be comparable or otherwise relevant Regional MACs will seek input on establishing pricing under the Medicare program for new laboratory test codes.
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