The CAP submitted comments to CMS raising concerns about preliminary 2027 Medicare Clinical Laboratory Fee Schedule (CLFS) rates that could significantly reduce payment for many laboratory tests.
By the numbers: CMS calculated new private payor-based rates for 1,528 laboratory codes. Of those, 1,171 would decrease compared with 2026 rates. CMS estimates the new rates are about 16% lower on average and would reduce Medicare CLFS spending by $1 billion annually.
Our concern: We maintain that Medicare rates should not be reduced based on data that may not accurately reflect the laboratory market Congress intended CMS to measure.
What we’re asking: We’re urging CMS not to reduce CLFS rates based on current data and to publish test volume by laboratory type so stakeholders can evaluate whether the data are representative and the resulting payment rates are reliable.
Looking ahead: We continue to support a permanent legislative solution to create a more representative and sustainable approach to setting Medicare laboratory payment rates.