Clinical Laboratory Test Payment (Medicare)
Current understanding
Medicare payment rates for clinical diagnostic laboratory tests are set under the Clinical Laboratory Fee Schedule (CLFS), with rates informed by reported private payer data under PAMA. Legislative proposals such as the RESULTS Act would restructure the data source by requiring CMS to contract with a nonprofit maintaining a private-sector claims database to inform payment rates for widely available lab tests.
Evidence log
- 2026-07-16 — Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program: 2026 — CY 2027 Physician Fee Schedule Proposed Rule: includes routine updates to the Medicare Clinical Laboratory Fee Schedule alongside broader Part B payment policy revisions. (novelty: 2) (novelty: 2)
- 2025-09-10 — RESULTS Act: 2026 — RESULTS Act (introduced): would require CMS to contract with a nonprofit maintaining a private-sector claims database to set Medicare Clinical Laboratory Fee Schedule payment rates for widely available clinical diagnostic laboratory tests beginning January 1, 2028. (novelty: 2)