Advocacy News

• Senate adopts 30-day delay of 2026 Medicare lab cuts
• How CAP advocacy protected Medicare pay for pathologists
• Virtual fly-in success fuels advocacy momentum
• Four ways your state society works for you
• Connecting. Growing. Thriving. Celebrating you.

Laboratories will get a brief reprieve from Medicare cuts if Congress enacts a Senate deal that came together over the weekend to end the government shutdown.

The impact: On January 1, more than 800 tests on the Medicare clinical laboratory fee schedule (CLFS) will decrease by up to 15% unless Congress acts.  

• The 30-day delay would give Congress and stakeholders more time to work on long-term payment reform.

Background: On November 9, a group of eight Democrats joined Senate Republicans to support a legislative package that ends the current shutdown and keeps the government open through January 30.  

• As part of that deal, Senators agreed to delay the Medicare cuts to the clinical laboratory fee schedule. These cuts have been delayed every year since the COVID-19 pandemic, via year-long, short-term patches.
• On November 10, the Senate voted 60-40 to pass the bill.
• The deal would need to pass the House before going to President Donald Trump to be signed into law.

Yes, but: While we are grateful for a short delay, we also need Congress to pass reforms that prevent these misguided reductions from threatening patient care and laboratory medicine in the future.  

• With foundational reform in place, Congress would no longer need to pass temporary delays year after year.

Take action: Encourage lawmakers to back the RESULTS Act to permanently fix these Medicare cuts. 

The 2026 Medicare Physician Fee Schedule was a mix of good and bad news for pathologists.

The impact: We reviewed adverse provisions, mainly the "efficiency adjustment," that will negatively affect pathology and laboratory pay in 2026.

• We are vigorously pushing back against these unjust and ill-conceived policies.

At the same time, we identified three pieces of good news in the fee schedule— which are the result of CAP advocacy.

• Our advocacy wins show that engaging with CMS and Congress can lead to positive change.

Pathologists' pay

The Centers for Medicare & Medicaid Services (CMS) says it will not use data from the American Medical Association’s Physician Practice Information Survey in its payment rate calculations.

• The CAP had strongly urged the CMS to set aside the survey due to serious concerns about sample sizes and statistical uncertainty.
• By CMS not implementing the survey data, pathologists will avoid an estimated 8% reduction in reimbursement.

Protecting the value of pathology services

The CAP has advocated fiercely for consistency in the application of the efficiency adjustment.

• We argued for the CMS to correctly classify pathology clinical consultations as time-based services and exempt them from the adjustment.
• The work relative value units (RVUs) for CPT codes 80503, 80504, 80505, and 80506 will remain unchanged and will not decrease by 2.5% in 2026.

As noted, the CAP is still strongly opposed to the overall finalization of the efficiency adjustment and is calling for congressional action to reverse payment cuts to our services.

Safeguarding the field of pathology

When the CMS finalized a policy to reduce facility practice expense RVUs, it acknowledged that services billed with the 26-modifier will be exempt from the site of service payment differential.

• As a result, the RVUs for most pathology services performed in the facility setting will not face a significant reduction.
• This important exemption follows extensive advocacy by the CAP, which urged the CMS to recognize that the proposed differential would have disproportionately affected pathologists and negatively affected patient care.

The CAP will continue to advocate against reductions to facility practice expense RVUs for pathology services that are not billed with the 26-modifier, including bone marrow, blood, and apheresis services. CAP members can also urge Congress to stop the Medicare payment cuts.

Go deeper: The CAP will review the final rule in a webinar at 3:00 PM ET on Friday, December 5. Register today!

Last week, the CAP held its virtual fly-in, where 41 members representing 19 states championed crucial issues in 44 meetings with House and Senate representatives.

Additionally, 150 CAP members sent action alerts to Congress, emphasizing the need to address payment cuts, workforce shortages in pathology, and other priority issues for pathologists.  

• Your participation in advocacy efforts strengthens the pathologists’ voice in legislative matters.  

What’s next: Keep the momentum going by sending an alert to your federal lawmakers. Use our Action Alert Center to make your voice heard.

Stay informed: Sign up for PathNET for updates on how you can be a part of our ongoing grassroots advocacy initiatives. 

State pathology societies play a vital role in helping pathologists grow professionally and make a difference within their local medical community.

How Membership Benefits You:

Expand your network: Build meaningful connections with colleagues, mentors, and collaborators across your state.

Stay current with CME opportunities: Gain access to state-level conferences, workshops, and educational programs that offer valuable CME credits.

Make a local impact: Engage in local and state advocacy efforts that shape health care policies and patient care.  

Advance your career: Discover professional development opportunities.

Dive in: Learn more about our State Society resources. 

Being part of the CAP means more than just membership; it’s belonging to a community of purpose. Wherever you are in your career, the CAP is here to support you, help you grow, and celebrate your impact on patient care.

Enjoy member perks including:

•    Save an extra 10% on CAP merchandise now through November 14. Use code APPRECIATE at checkout.
•   Explore new benefits like CAP On Demand and the AI Studio.
•   Join PathTogether, our new online community, to network with fellow members.  

Use #CAPMemberAppreciation to share your pride on social media.

Thank you for being an integral part of the CAP!