Clinical Laboratory Services Rate Methodology
Hloov Kho Tshiab Lub Tsib Hlis 2026:
Xyoo 2026 Kev Hloov Kho Tus Nqi ntawm Cov Chaw Kuaj Mob Los Ntawm Daim Ntawv Qhia
Cov kev hloov kho tus nqi hauv qab no tam sim no raug siv los ntawm xyoo 2026 Kev Tshawb Fawb Hauv Chaw Kho Mob thiab Kev Tshaj Tawm Tus Nqi Hloov Kho uas yuav siv tau rau lub Xya Hli 1, 2026.
Txheej Txheem Cai | piav qhia | Lub Xya Hli 1, 2026 Tus nqi |
0134U | HERED PAN CA MRNA PNL 18 GEN | $ 748.39 |
0211U | ONC PAN-TUM DNA&RNA GNRJ SEQ | $ 8,455.00 |
0340U | ONC PAN CA ALYS MRD PLASMA | $ 3,590.00 |
0345U | PSYC GENOM ALYS PNL 15 GEN | $ 1,336.09 |
0356U | ONC OROP/ANAL 17 DNA DDPCR | $ 1,800.00 |
0402U | NFCT AGT STI MULT AMP PRB TQ | $ 142.63 |
0421U | ONC CLRCT SCR SGL AMP 8 RNA | $ 508.87 |
0445U | ABETA42 & PTAU181 ECLIA CSF | $ 260.50 |
0455U | NFCT AGT STI MULT AMP PRB UR | $ 142.63 |
0459U | ABETA42 & TTAU ECLIA CSF | $ 260.50 |
0464U | ONC CLRCT SCR QRTSA DNA MRK | $ 591.92 |
0485U | ONC SOL TUM CFDNA&RNA NGS GM | $ 3,649.48 |
0487U | ONC SOL TUM CFCDNA TGSAP 84 | $ 2,919.60 |
0514U | GI IBD IA QUAN DETER ADL LVL | $ 38.57 |
0515U | GI IBD IA QUAN DETER IFX LVL | $ 38.57 |
0523U | ONC SOLTUM DNA NGS SNV 22GEN | $ 1,352.09 |
0528U | LRT IAD 18BCT/8VIR&7ARG RNA | $ 634.84 |
0540U | TRNSPLJ MED QUAN DD-CFDNA | $ 2,753.25 |
0543U | ONC SOL TUM NGS DNA 517 GENS | $ 2,989.55 |
0563U | NFCT DS PTHGN-SNA 11VIR&4BCT | $ 416.78 |
0564U | NFCT DS PTHGN-SNA 10VIR&4BCT | $ 416.78 |
0580U | BBRGDRFERI ANTB DETC 24RPRTN | $ 17.21 |
0588U | NFCT DS BCT/VIR 32GENES MRNA | $ 760.00 |
0595U | NFCT DS TFP VCTRBRN&ZOONOTIC | $ 262.99 |
81425 | KEV TSOM XAM TXOG GENOME SEQUENCE | $ 5,031.20 |
81426 | KEV TSOM XAM TXOG GENOME SEQUENCE | $ 2,709.95 |
81427 | KEV NTSUAM XYUAS GENOME DUA | $ 2,337.65 |
82233 | BETA-AMYLOID 1-40 (ABETA 40) | $ 128.92 |
82234 | BETA-AMYLOID 1-42 (ABETA 42) | $ 128.92 |
84393 | TAU PHOSPHORYLATED EA | $ 128.92 |
84394 | TAG NRHO TAU | $ 128.92 |
86581 | STRPTCS PNEUM ANTB SEROT IA | $ 92.03 |
87183 | SC STD CARBAPENEM RESIST GEN | $ 35.09 |
87494 | CHLMY TRCH&NEISRA GONOR MULT | $ 70.18 |
87627 | JT SPC PTHGN&RX RSIST GEN26+ | $ 679.77 |
87812 | SARSCOV2&INF TYP A&B W/OPTIC | $ 74.48 |
G0567 | TSHUAJ NTSUAM XYUAS HEP C DETECT | $ 35.09 |
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:
Please submit completed attestation, submission forms, questions, or comments, to the 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:
Please submit completed submission forms, questions, or comments, to the DHCS Clinical Laboratory mailbox: labcomments@dhcs.ca.gov
Keeb kwm
Raws li Assembly Bill (AB) 1494 (Pawg Neeg Saib Xyuas Kev Siv Nyiaj), DHCS yuav tsum tau ua raws li nram no:
Tsim ib txoj kev teeb tsa tus nqi tshiab rau kev kuaj mob lossis kev pabcuam kuaj mob raws li qhov nruab nrab ntawm cov nqi qis tshaj plaws uas lwm tus neeg them nyiaj sab nraud them rau cov kev pabcuam zoo sib xws.
Txij li Lub Xya Hli 1, 2015, txoj kev ntsuas tus nqi tshiab yuav raug siv raws li SPA 15-015 uas tau pom zoo.
Siv kev txo nqi them 10 feem pua, tsis suav nrog cov kev pabcuam raws li Txoj Haujlwm Npaj Tsev Neeg, Kev Nkag Mus, Kev Saib Xyuas thiab Kev Kho Mob (FPACT) thiab cov kev pabcuam hauv tsev kho mob sab nraud, siv tau txij lub Xya Hli 1, 2012 txog rau Lub Rau Hli 30, 2015, rau cov chaw kuaj mob thiab cov kev pabcuam hauv chaw kuaj mob kom txog thaum pom zoo rau txoj kev teeb tsa tus nqi tshiab los ntawm Lub Chaw rau Medicaid & Medicare Services (CMS).
Qhov kev txo nqi them 10 feem pua tau siv raws li SPA 12-028 tau pom zoo.
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 kev sib tham nrog cov neeg koom nrog hauv chaw kuaj mob kom tsim tau ib txoj kev sau cov ntaub
uas ua tau thiab ua raws li lub
phiaj ntawm txoj cai lij choj. DHCS tau thov cov ntaub ntawv txog tus nqi them thiab kev siv ntawm tus neeg thib peb los ntawm cov chaw muab kev pabcuam thiab txwv kev siv cov ntaub ntawv rau cov lej uas ua tau raws li ob qho kev txwv hauv qab no raws li cov ntaub ntawv thov Medi-Cal them nyiaj 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 pej xeem feem ntau
Tus nqi uas siv rau ntawm daim ntawv teev nqi Medi-Cal rau lub xyoo nyiaj txiag tam sim no, uas yuav yog qhov qis tshaj plaws ntawm cov hauv qab no:
Tus nqi uas siv rau ntawm daim ntawv teev nqi Medi-Cal txij li Lub Rau Hli 30 ntawm lub xyoo nyiaj txiag yav dhau los; lossis
100 feem pua ntawm qhov nyiaj pub dawb qis tshaj plaws uas tau tsim los ntawm daim ntawv teev nqi Medicare Clinical Laboratory thiab daim ntawv teev nqi Medicare Kws Kho Mob uas siv tau rau Lub Ib Hlis 1 ntawm lub xyoo nyiaj txiag yav dhau los 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 utilizes the data collected to develop the clinical laboratory reimbursement rates. The following represents the steps taken in the determination of the average of the lowest rate.
- 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.
- 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. .
- 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.
Yuav kom ntseeg tau tias cov kev cai ntawm cov kev cai lij choj txuas ntxiv mus raws li, DHCS yuav sau cov ntaub ntawv tus nqi them thiab kev siv ntawm tus neeg thib peb txhua peb xyoos, pib xyoo 2019, los ntawm cov chaw kuaj mob lossis cov chaw muab kev pabcuam hauv chaw kuaj mob. Pib txij lub Xya Hli 1, 2020, thiab txhua peb xyoos tom qab ntawd, cov nqi yuav tsum tau suav raws li cov ntaub ntawv xyoo dhau los thiab kev siv cov txheej txheem yuav raug txwv rau cov lej uas ua tau raws li ib qho ntawm ob qho kev txwv. DHCS yuav txuas ntxiv saib xyuas cov kev txwv thiab cov txheej txheem thiab hloov pauv raws li qhov tsim nyog kom ua raws li txoj cai, cov kev cai nkag mus, thiab suav nrog lwm yam teeb meem kev ua haujlwm lossis kev pab cuam.
Hu rau DHCS
Cov lus nug lossis cov lus pom tuaj yeem xa mus rau DHCS Clinical Laboratory email box: labcomments@dhcs.ca.gov.