Clinical Laboratory Services Rate Methodology
Lub Yim Hli 2025 Hloov tshiab:
Sau cov chaw soj ntsuam kuaj mob lossis chaw kuaj mob rau xyoo 2024 Cov ntaub ntawv
Hnub kawg ntawm kev xa mus rau qhov chaw kuaj mob lossis chaw kuaj mob cov ntaub ntawv tau txuas ntxiv mus rau Lub Yim Hli 31, 2025. Kev tsis muab cov ntaub ntawv xav tau hauv 30 hnub ua haujlwm txij li lub sijhawm thov los ntawm DHCS tuaj yeem ua rau raug ncua los ntawm Medi-Cal qhov kev pab cuam raws li WIC Tshooj 14105.22(a)(5)(G).
Lub Xya Hli 2025 Hloov Kho:
Sau cov chaw soj ntsuam kuaj mob lossis chaw kuaj mob rau xyoo 2024 Cov ntaub ntawv
Hnub kawg ntawm kev xa mus rau cov ntaub ntawv kho mob hauv chaw kuaj mob tau txuas ntxiv mus rau Lub Xya Hli 31, 2025.
Lub Plaub Hlis 2025 Hloov tshiab:
Xyoo 2024 Clinical Laboratory lossis Laboratory Services Data Collection Provider Webinar
DHCS tab tom tuav ob lub vev xaib xov xwm uas yuav pab cov neeg muab kev pabcuam ua kom tiav Xyoo 2024 Clinical Laboratory lossis Laboratory Services Cov Ntaub Ntawv Sau Cov Ntaub Ntawv xa tawm, kom txog rau thaum Lub Rau Hli 30th, 2025.
Hnub thiab sijhawm rau ob lub webinars yog raws li hauv qab no:
- Tuesday, Plaub Hlis 29, 2025, 1:00 PM PST
- Wednesday, May 28, 2025, 3:00 PM PST
Yog tias koj xav koom nrog peb cov kws kho mob webinars, thov email rau peb ntawm labcomments@dhcs.ca.gov.
Lub Ob Hlis 2025 Hloov tshiab:
Calendar Xyoo 2024 Clinical Laboratory lossis Laboratory Services Data Collection
Raws li thawj kauj ruam hauv kev txhim kho Lub Xya Hli 1, 2026, lab tus nqi them rov qab, qee tus neeg muab kev pabcuam yuav tsum xa tus neeg thib peb tus nqi them thiab cov ntaub ntawv siv rau xyoo 2024. Cov ntaub ntawv xa tuaj yuav tsum xa mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) ua ntej Lub Rau Hli 30, 2025. Cov npe tau muab hauv qab no txheeb xyuas cov txheej txheem cov cai raws li kev tshaj tawm thiab cov chaw muab kev pabcuam los ntawm National Provider Identifier (NPI) tus lej uas yuav tsum tau xa cov ntaub ntawv:
Thov saib DHCS Daim Ntawv 6015 hauv qab no rau daim ntawv pov thawj, cov lus qhia thiab daim ntawv xa mus:
Thov xa daim ntawv pov thawj ua tiav, daim ntawv xa mus, cov lus nug, lossis cov lus pom, mus rau DHCS Clinical Laboratory mailbox: labcomments@dhcs.ca.gov.
Lub Peb Hlis 2024 Hloov tshiab:
Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau suav cov nqi kuaj mob hauv tsev kho mob, pib lub Xya Hli 1, 2023 ua raws li California Welfare thiab Institutions Code tshooj 14105.22.
Thaum Lub Kaum Ib Hlis 8, 2023, Lub Chaw rau Medicare & Medicaid Services (CMS) tau pom zoo SPA 23-0019. Cov txheej txheem cov cai nrog cov nqi hloov kho raws li SPA 23-0019 muaj npe hauv qab no. Cov nqi tshiab no siv tau rov qab rau lub Xya Hli 1, 2023.
|
Txheej Txheem Cai |
Code piav qhia |
Lub Xya Hli 1, 2023 Tus nqi |
80307
| DRUG TEST PRSMV CHEM ANLYZR | $ 43.50 |
| 86480 | TB TEST CELL IMMUN Measure | $ 43.39 |
| 87529 | HSV DNA AMP PROBE | $ 24.56 |
| 80074 | ACUTE Hepaticis Panel | $ 34.86 |
| 87522 | Hepatitis C REVRS TRNSCRPJ | $ 31.51 |
| 87591 | N.GONORRHOEAE DNA AMP PROB | $ 25.36 |
| 87491 | CHYLMD TRACH DNA AMP PROBE | $ 25.59 |
| 82306 | VITAMIN D 25 HYDROXY | $ 20.72 |
| 84154 | QHIA PSA DAWB | $ 12.87 |
| 88313 | TXOJ CAI TXOJ CAI GROUP 2 | $ 34.26 |
| 86147 | CARDIOLIPIN ANTIBODY EA IG | $ 17.82 |
| 86800 | THYROGlobulin ANTIBODY, RIA | $ 11.14 |
| 83525 | QHOV TSEEM CEEB ntawm insulin | $ 8.00 |
| 86317 | IMMUNOASSAY INFECTIUS Agent | $ 10.49 |
| 84481 | KEV PAB CUAM DAWB (FT-3) | $ 11.93 |
| 86255 | FLUORESCENT ANTIBODY SCREEN | $ 8.63 |
| 87086 | URINE CULTURE/COLONY COUNT | $ 5.65 |
| 87324 | CLOSTRIDIUM AG IA | $ 8.39 |
| 84436 | QHIA NTAWM TAG NRHO THYROXINE | $ 5.18 |
| 87177 | OVA thiab cov kab mob SMEARS | $ 7.18 |
| 86592 | SYPHILIS TEST NO-TREP QUAL | $ 3.18 |
| 87045 | FECES CULTURE AEROBIC BACT | $ 7.85 |
| 87077 | CULTURE AEROBIC IDENTIFY | $ 6.65 |
| 87147 | CULTURE HOM IMMUNOLOGIC | $ 3.63 |
| 86141 | C-REACTIVE PROTEIN HS | $ 11.06 |
| 80053 | * 00 COMPRHENSIVE METABOLIC Vaj Huam Sib Luag | $ 9.19 |
| 87186 | MICROBE SUSCEPTIBLE MIC | $ 7.51 |
Lub Ob Hlis 2022 Hloov tshiab:
Calendar Xyoo 2021 Clinical Laboratory lossis Laboratory Services Data Collection
Raws li thawj kauj ruam hauv kev tsim lub Xya Hli 1, 2023 lab tus nqi them rov qab, qee tus neeg muab kev pabcuam yuav tsum xa tus neeg thib peb tus nqi them thiab cov ntaub ntawv siv rau xyoo 2021. Cov ntaub ntawv xa tuaj yuav tsum xa mus rau Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) ua ntej Lub Rau Hli 30, 2022. Cov npe tau muab hauv qab no txheeb xyuas cov txheej txheem cov cai raws li kev tshaj tawm thiab cov chaw muab kev pabcuam los ntawm National Provider Identifier (NPI) tus lej uas yuav tsum tau xa cov ntaub ntawv:
Thov saib DHCS Daim Ntawv 6015 hauv qab no rau cov lus qhia thiab daim ntawv xa mus:
Thov xa cov ntaub ntawv xa mus, cov lus nug, lossis cov lus pom, xa mus rau DHCS Clinical Laboratory mailbox:
labcomments@dhcs.ca.gov
Keeb kwm
Raws li tsab cai Assembly Bill (AB) 1494 (Committee on Budget), DHCS yuav tsum:
- Tsim cov txheej txheem kev teeb tsa tus nqi tshiab rau cov chaw kuaj mob lossis chaw kuaj mob raws li qhov nruab nrab ntawm cov nqi qis tshaj lwm tus neeg sab nrauv them rau cov kev pabcuam zoo sib xws.
- Pib txij Lub Xya Hli 1, 2015, tus txheej txheem tshiab tus nqi yog siv raws li kev pom zoo SPA 15-015.
- Ua kom txo qis 10 feem pua, tsis suav nrog cov kev pabcuam hauv Family Planning, Access, Care thiab Treatment (FPACT) thiab cov kev pabcuam hauv tsev kho mob sab nraud, pib lub Xya hli ntuj 1, 2012 txog rau Lub Rau Hli 30, 2015, rau kev kuaj mob thiab kev kuaj mob kom txog rau thaum tus nqi tshiab tau txais kev pom zoo los ntawm Lub Chaw rau Medicaid & Medicare Services (C.
- Qhov kev txo qis 10 feem pua yog ua raws li kev pom zoo SPA 12-028.
Raws li txoj cai lij choj, AB 97 kev them nyiaj txo qis kuj tseem siv rau txoj kev them nyiaj tshiab.
Cov txheej txheem sau cov ntaub ntawv
DHCS tau dhau los ua cov txheej txheem tseem ceeb los tsim cov cuab yeej sau cov ntaub ntawv los siv rau kev txhim kho cov txheej txheem tshiab thiab txiav txim siab tus nqi tshiab raws li txoj kev ntawd.
Pib xyoo 2012, DHCS tau ua cov rooj sib tham nrog cov neeg koom nrog hauv chaw kuaj mob los tsim cov txheej txheem sau cov ntaub ntawv uas ua haujlwm tau zoo thiab ua raws li lub hom phiaj ntawm txoj cai.
DHCS tau thov tus neeg thib peb tus nqi them thiab kev siv cov ntaub ntawv los ntawm cov chaw muab kev pabcuam thiab txwv tsis pub siv cov ntaub ntawv rau cov lej uas ua tau raws li ob qho hauv qab no raws li cov ntaub ntawv them nyiaj Medi-Cal xyoo dhau los:
- Medi-Cal cov ntaub ntawv them nqi sib npaug lossis ntau dua 1,000
- Tag nrho Medi-Cal them tus nqi sib npaug los yog ntau dua $500,000
Cov theem pib ntawm kev xaiv cov kws kho mob yuav tsum xa cov ntaub ntawv siv yog:
- Medi-Cal cov ntaub ntawv them nqi sib npaug lossis ntau dua 5,000
- Tag nrho Medi-Cal them tus nqi sib npaug los yog ntau dua $100,000
Rate Methodology
Kev them nyiaj rov qab rau cov chaw kuaj mob lossis chaw kuaj mob yuav tsum tsis pub tshaj qhov qis tshaj ntawm cov hauv qab no:
- Tus nqi them,
- Tus nqi rau cov pej xeem
- Tus nqi uas muaj feem rau ntawm Medi-Cal cov nqi them rau lub xeev lub xyoo tam sim no, uas yuav tsum yog qhov qis tshaj ntawm cov hauv qab no:
- Tus nqi siv rau ntawm Medi-Cal cov nqi them txij li lub Rau Hli 30 ntawm lub xeev cov nyiaj txiag xyoo dhau los; los yog
- 100 feem pua ntawm cov nyiaj qis tshaj plaws uas tau tsim los ntawm tsoomfwv Medicare Clinical Laboratory tus nqi teem sijhawm thiab Medicare Tus Kws Khomob tus nqi teem sijhawm pib txij Lub Ib Hlis 1 ntawm lub xyoo dhau los ntawm lub xeev cov kev pabcuam rau tib yam lossis zoo sib xws.
4. Pib txij Lub Xya Hli 1, 2023, thiab txhua peb xyoos tom qab ntawd, qhov nruab nrab qhov hnyav ntawm qhov qis tshaj plaws uas cov neeg sab nrauv them rau cov kev pabcuam tib yam lossis zoo sib xws, tab sis tsis pub tsawg dua 70 feem pua ntawm Medicare Clinical Laboratory tus nqi thiab Medicare Tus kws kho mob tus nqi pib txij Lub Ib Hlis 1 ntawm lub xyoo dhau los ntawm lub xeev cov kev pabcuam rau tib yam lossis zoo sib xws.
Triennially, DHCS siv cov ntaub ntawv khaws tseg los tsim cov nqi kho mob hauv chaw kuaj mob. Cov hauv qab no sawv cev rau cov kauj ruam ua hauv kev txiav txim siab ntawm qhov nruab nrab ntawm tus nqi qis tshaj.
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DHCS suav qhov hnyav nruab nrab ntawm tus nqi qis tshaj plaws uas lwm tus neeg them nyiaj tau them rau tib yam lossis zoo sib xws hauv chaw kuaj mob lossis chaw kuaj mob raws li cov ntaub ntawv sau los ntawm cov kws kho mob.
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Txhawm rau hais txog qhov muaj peev xwm ntawm outliers nyob rau hauv cov ntaub ntawv them nyiaj thib peb, rau cov lej nrog qhov hnyav nruab nrab ntawm kev lag luam ntau dua 30% qis dua tus nqi Medicare tam sim no, DHCS tau siv lub backstop los teeb tus nqi tsawg dua 70% ntawm Medicare. .
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Cov txheej txheem yog ib tus zuj zus siv rau txhua tus lej raws li qhov yuav tsum tau ua, tsis suav nrog cov lej uas tsis muaj tus neeg thib peb tus nqi thiab/lossis cov ntaub ntawv siv tau raug xa mus, lossis yog tias cov kev pabcuam raws li cov cai ntawd raug txiav lossis tsis tau txais txiaj ntsig Medi-Cal lawm.
Txhawm rau kom ntseeg tau tias cov cai ntawm cov kev cai lij choj tau ua tiav, DHCS yuav sau cov neeg thib peb tus nqi them thiab cov ntaub ntawv siv txhua peb xyoos, pib xyoo 2019, los ntawm cov chaw kuaj mob lossis chaw kuaj mob. Pib txij Lub Xya Hli 1, 2020, thiab txhua xyoo tom qab ntawd, rates yuav tsum tau muab xam raws li cov ntaub ntawv xyoo dhau los thiab kev siv cov txheej txheem yuav raug txwv rau cov lej sib ntsib ntawm ob qho kev pib. DHCS yuav txuas ntxiv saib xyuas cov theem pib thiab cov txheej txheem thiab hloov pauv raws li qhov tsim nyog ua raws li txoj cai lij choj, kev nkag mus rau cov cai, thiab suav nrog lwm yam teeb meem kev ua haujlwm lossis kev ua haujlwm.
Hu rau DHCS
Cov lus nug lossis cov lus pom tuaj yeem xa mus rau DHCS Clinical Laboratory email box: labcomments@dhcs.ca.gov.
Kev cai lij choj
