Audit of Medicaid Reimbursement for Clinical Laboratory Services

Outpatient clinical diagnostic laboratory tests encompass tests performed in a physician's office, by an independent laboratory, or by a hospital laboratory, and provide information for the diagnosis, prevention, or treatment of disease or for the assessment of a medical condition. Medicaid reimbursement for outpatient clinical diagnostic laboratory services performed in a physician's office, by an independent laboratory, or by a hospital laboratory, generally may not exceed the amount set in the Medicare clinical laboratory fee schedule. Our objective is to determine whether selected States claimed Federal Medicaid reimbursement for outpatient clinical diagnostic laboratory services in accordance with the payment limits set in Federal and State requirements.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
October 2024	Centers for Medicare and Medicaid Services	Audit of Medicaid Reimbursement for Clinical Laboratory Services	Office of Audit Services	OAS-25-01-004	2026