# 42 C.F.R. § 414.522 (2026): Payment for new advanced diagnostic laboratory tests

> Federal · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_522

## Section

- **Citation:** 42 C.F.R. § 414.522 (2026)
- **Heading:** Payment for new advanced diagnostic laboratory tests
- **Jurisdiction:** Federal
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Title 42 CFR: Public Health / Chapter IV: CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES / Part 414: PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES / Subpart G: Payment for Clinical Diagnostic Laboratory Tests / § 414.522: § 414.522   Payment for new advanced diagnostic laboratory tests.

## Text

(a) The payment rate for a new ADLT—
(1) During the new ADLT initial period, is equal to its actual list charge.
(2) Prior to the new ADLT initial period, is determined by the Medicare Administrative Contractor based on information provided by the laboratory seeking new ADLT status for its laboratory test.
(b) After the new ADLT initial period, the payment rate for a new ADLT is equal to the weighted median established under the payment methodology described in § 414.507(b).
(c) If, after the new ADLT initial period, the actual list charge of a new ADLT is greater than 130 percent of the weighted median established under the payment methodology described in § 414.507, CMS will recoup the difference between the ADLT actual list charge and 130 percent of the weighted median.
(d) If CMS does not receive any applicable information for a new ADLT by the last day of the second quarter of the new ADLT initial period, the payment rate for the test is determined either by the gapfilling or crosswalking method as described in § 414.508(b)(1) and (2).
[81 FR 41100, June 23, 2016]

## Nearby sections

- [42 C.F.R. § 414.500 (2026) § 414.500   Basis and scope.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_500.md)
- [42 C.F.R. § 414.502 (2026) § 414.502   Definitions.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_502.md)
- [42 C.F.R. § 414.504 (2026) § 414.504   Data reporting requirements.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_504.md)
- [42 C.F.R. § 414.506 (2026) § 414.506   Procedures for public consultation for payment for a new clinical diagnostic laboratory test.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_506.md)
- [42 C.F.R. § 414.507 (2026) § 414.507   Payment for clinical diagnostic laboratory tests.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_507.md)
- [42 C.F.R. § 414.508 (2026) § 414.508   Payment for a new clinical diagnostic laboratory test.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_508.md)
- [42 C.F.R. § 414.509 (2026) § 414.509   Reconsideration of basis for and amount of payment for a new clinical diagnostic laboratory test.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_509.md)
- [42 C.F.R. § 414.510 (2026) § 414.510   Laboratory date of service for clinical laboratory and pathology specimens.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_510.md)
- [42 C.F.R. § 414.522 (2026) § 414.522   Payment for new advanced diagnostic laboratory tests.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_522.md)
- [42 C.F.R. § 414.523 (2026) § 414.523   Payment for laboratory specimen collection fee and travel allowance.](https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_523.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/CFR_T42_P414_S414_522. Check the current official text before relying on it. Not legal advice.