The annual update to local clinical laboratory fees will be 2.6 percent in 2004, the Centers for Medicare & Medicaid Services says in a Nov. 7 "one-time notification" (Change Request 2959). For tests for which a national limitation amount was set before Jan. 1, 2001, the NLA will be 74 percent of the median of the local fees, the agency adds in the update to the CMS Manual System. In a second one-time notification this week, CMS updates the Healthcare Common Procedure Coding System codes subject to the consolidated billing provisions of the home health prospective payment system (CR 2931). To see the transmittals, go to http://cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.