Medicare Physician and Laboratory Fee Schedules Need Reform, ASCP Argues

• ASCP’s opposed cuts to Medicare reimbursement for pathology, laboratory services 

• ASCP urged CMS to reimburse providers for software expenses, such as AI, algorithms, etc. 

• ASCP asked the Agency to reduce the regulatory burden of the Quality Payment Program 

On September 12, ASCP submitted formal comments to the Centers for Medicare and Medicaid Services (CMS), urging changes to its CY 2026 Medicare Physician Fee Schedule Proposed Rule. ASCP opposed the agency’s proposal to impose a triennial efficiency adjustment of -2.5 percent on most physician services, and a site of service payment differential that could reduce hospital-based (facility) payments by 7 percent. ASCP urged CMS to work with Congress to secure an annual update to address rising costs.  

The efficiency update would have had a significant impact on pathologists. A recent report by the Medicare Payment Advisory Commission identified pathologists as one of 9 medical specialties with at least 60 percent of providers furnishing 90 percent or more of their services in a facility setting.   

In addition, ASCP outlined support for a request for information on whether and how to provide reimbursement for software, such as artificial intelligence, algorithms, etc., used in the provision of medical services.   

ASCP also raised concern about the Clinical Laboratory Fee Schedule (CLFS). In past years, Congress, which recognized serious flaws with the Agency’s payment rate setting methodology for the CLFS, has blocked CMS from cutting these payment rates. Since it is unclear whether Congress will do so again this year, ASCP urged the agency not to cut this fee schedule by the full amounts allowed under Section 216 of the Protecting Access to Medicare Act.   

An estimated 820 test codes could be cut by as much as 15 percent. ASCP also urged the agency to update PAMA’s data collection and reporting periods from 2019/2020 to 2026/2027, noting that using such old data would amount to a significant cut given the amount of inflation that has occurred since 2019 is approximately 28 percent.  

Lastly, ASCP weighed in on CMS’s Quality Payment Program/Merit-based Incentive Payment System (MIPS), urging the agency to reduce the compliance burden on physicians. ASCP signaled its support for the newly developed Pathology MIPS Value Pathway but urged that reporting be incentivized rather than mandated. ASCP also joined with the AMA and other medical societies in a recent letter on the quality payment program.