Protecting Access to Medicare Act

What is PAMA?

The Protecting Access to Medicare Act of 2014 (PAMA) significantly revises the Medicare payment system for clinical diagnostic laboratory tests by requiring that Medicare payment for clinical laboratories be based on the weighted median of private payer rates along with a number of other provisions.

Laboratories are required to report HCPCS laboratory codes, associated private payor rates, and volume data if they have more than $12,500 in Medicare revenues from laboratory services on the Clinical Laboratory Fee Schedule (CLFS) and receive more than 50% of their Medicare revenues from laboratory and physician services during a collection period.