Medicare Laboratory Payment Cuts Averted for 2026

• Legislation recently signed into law ending the partial government shutdown also blocks cuts to the Medicare Clinical Laboratory Fee Schedule for 2026 

• Under the new law, laboratories are required to report payment rate data to CMS between May 1 and July 31 

• If Congress enacts the RESULTS Act before the reporting requirement begins, the reporting requirement would be canceled for most laboratories 

• ASCP asks its membership to take action and visit the STOP LAB CUTS website to urge Congress to enact the RESULTS Act as soon as possible. 

On February 3, the President signed into law several bills ending the partial government shutdown that began on January 31. The measures provide funding for seven federal departments, including Health and Human Services (HHS). Also signed into law was a separate two-week funding bill for the Department of Homeland Security. 

Included in the bill funding HHS were provisions providing short term relief from a series of cuts imposed by the Protecting Access to Medicare Act (PAMA). Approximately 800 laboratory services were slated to be cut by up to 15 percent, beginning January 31. These cuts are now blocked for the remainder of 2026. In addition, the measure pushes back, but does not stop, Congress’s plan for clinical laboratories to begin reporting payment rate data. The window for reporting will begin on May 1, with applicable laboratories expected to satisfy the reporting requirement by July 30. The Centers for Medicare and Medicaid (CMS) are reportedly working on education materials intended to inform clinical laboratories of their upcoming reporting obligation. 

While the reporting requirement will likely prove challenging for many laboratories, the recently passed legislation buys time to enact the RESULTS Act (The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act [S. 2761 / H.R. 5269]), which would bring needed reform to PAMA. PAMA tasked CMS with revising Medicare payment rates for laboratory services. The new fee structure CMS developed created an entirely new set of payment rates for laboratory services, based on payment data submitted by clinical laboratories. The revamped fee schedule imposed severe cuts in payment to laboratories, totaling more than $4 billion in Medicare payments so far. In addition, insurers used CMS’s new rates to impose additional cuts in laboratory reimbursement. The result has caused significant economic hardship for laboratories and laboratory staff. For more on PAMA and the reporting requirement, see here. 

The RESULTS Act would change PAMA’s requirements by using paid claims from a comprehensive commercial payor database, eliminating the need for most laboratories to report data for most tests (labs with tests identified in PAMA as Advanced Diagnostic Laboratory Tests would still need to report data). It would also provide CMS with more robust, reliable data for setting more reliable payment rates. The RESULTS Act would also block further payment cuts until new rates can be set.  

At this time, ASCP is urging its entire membership to urge Congress to enact the RESULTS Act as soon as possible. To facilitate this, ASCP members and their colleagues are asked to utilize the STOP LAB CUTS website to send Congress this important message. Click here to TAKE ACTION.