PAMA's 2027 CLFS reset: What diagnostics leaders need to do now
Preliminary 2027 CLFS medians point to lower reimbursement for many laboratory tests. Diagnostics leaders should assess exposure by code, review Medicare-linked contracts, and plan how to protect portfolio economics and margins through 2029.
CMS’s proposed laboratory rate changes will lead to decreases in reimbursement across a number of codes. If these changes are implemented, the commercial implications could extend well beyond Medicare and will continue to have an impact beyond 2027.
On September 21st, CMS published preliminary private-payer (including managed care vendors) medians for the 2027 Clinical Laboratory Fee Schedule (CLFS). The agency reports an average potential change of approximately 16% below 2026 rates for tests with a calculable median. However, this is not uniform across…
