US · guidance
CMS Pub. 100-04, ch. 16, § 40.3.1
Critical Access Hospital (CAH) Outpatient Laboratory Service
Effective for services furnished on or after the enactment of the Balanced Budget Refinement Act of 1999
(BBRA), Medicare beneficiaries are not liable for any coinsurance, deductible, co-payment, or other cost
sharing amount with respect to clinical laboratory services furnished as a CAH outpatient service. This
change is effective for claims with dates of service on or after November 29, 1999.
For CAH bill type 85X, the laboratory fees are paid at 101 percent of reasonable cost. When the CAH bills a
14X bill type as a non-patient laboratory specimen, it is paid on the clinical laboratory fee schedule.
History
(Rev. 2971, Issued: 05-23-14, Effective: 07-01-14, Implementation: 07-07-14)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6336965d6634f59e2d0464ec1635a3e7579279274ae3e1a7a508ddcaa9e9504e
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