CMS released preliminary 2027 Medicare lab rates, showing potential cuts of 23% for genomic sequencing and 22% for molecular pathology. Most beneficiaries’ out-of-pocket costs for covered tests would not change directly; final rates are expected in November.
CMS calculated the preliminary weighted median rates using updated private-insurer payment data collected under the 2014 PAMA law. It says Medicare has paid about 16% more than private insurers for lab services and estimates the changes could save taxpayers roughly $1 billion annually. Federal law caps annual decreases for each lab test at 15% through 2029, so larger reductions would be phased in.
CMS's figures also show potential average reductions of 19.3% for microbiology and immunology, 16% for chemistry and 2.4% for proprietary laboratory analysis. Quest Diagnostics says the PAMA system does not collect sufficiently representative private-payer data and urged Congress to pass the RESULTS Act; the American Clinical Laboratory Association says nearly 1,200 tests could face reductions, including hundreds at the 15% cap in 2027. Lab groups warn cuts could affect access in rural and underserved areas. CMS is accepting public comments for 30 days.