CMS Pub. 100-04, ch. 23, § 40.1

The annual laboratory fee schedule data file should be retrieved electronically through CMS’ mainframe

telecommunications system.

For each test code, if the MAC’s system retains only the pricing amount, they should load the data from the

field named “60% Pricing Amt.” For each test code, if the MAC’s system has been developed to retain the

local fee and the NLA, they may load the data from the fields named “60% Local Fee Amt” and “60% Natl

Limit Amt” to use to determine payment. For clinical laboratory test codes for cervical or vaginal smear

tests (listed in Chapter 16, “Laboratory Services from Independent Labs, Physicians, and Providers,” §80.3)

load the data from the field named “60% Pricing Amt” to reflect the lower of the local fee or the NLA, but

not less than the national minimum payment amount. The fields named “62% Local Fee Amt,” “62% Natl

Limit Amt,” and “62% Pricing Amt” should be used by A/B MACs (A) for payment of clinical laboratory

tests performed by a sole community hospital’s qualified laboratory.

The annual laboratory fee schedule data is available via the CMS website. It is available in multiple

formats: Excel, text, and comma delimited.