HI 00401.330 Negotiated Rates for Laboratory Services

The Secretary is authorized to enter into agreements with laboratories under which Medicare payments for diagnostic laboratory tests will be on the basis of negotiated rates which will be the full charges. Since the laboratories will not bill Medicare beneficiaries for deductible and coinsurance amounts, cost savings for both the laboratories and the program will result.

This provision applies only to diagnostic laboratory tests for which payment is to be made to a laboratory on the basis of assignment. Further, the negotiated rates may not exceed the payments that would have been made in the absence of such rates.

Payments made to a laboratory under an agreed-upon rate will have been calculated to assure that program liability will be no more than had payment been based on the reasonable charge subject to the deductible and coinsurance amounts. Under the agreement, when reimbursement is based on a negotiated rate, the laboratory accepts the amount as payment in full.