The Centers for Medicare & Medicaid Services released additional data on the private payor information used to calculate preliminary 2027 Medicare Clinical Laboratory Fee Schedule (CLFS) rates. The data show substantial differences in the share of reported test volume coming from different laboratory settings.
By the numbers:
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Hospital laboratories: 9.9% of reported test volume.
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Physician office laboratories: 11.3%.
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Independent laboratories: 76.5%.
Our concern: The new information reinforces concerns raised in our recent comments about whether the data used to establish Medicare laboratory payment rates are sufficiently comprehensive and representative of the laboratory market.
The bigger picture: The CAP continues to support reforms that would produce more representative data and a more sustainable approach to Medicare laboratory payment.