Medical Fee Schedule

Listing of medical procedure codes and descriptions with fees and relative value units.

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

Miriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.