Lab reimbursement update

Jan. 12, 2026

6 min read

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The House Energy and Commerce Subcommittee on Health held a hearing January 8^th to discuss legislation on Medicare payment policies and services for seniors, including the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act. The RESULTS Act consists of reforms to the Medicare Clinical Laboratory Fee Schedule and would ensure the CLFS rate-setting process is based on up-to-date commercial market data representative of independent, hospital outreach, and physician office labs. The bill would also reduce administrative data collection and reporting burden on clinical laboratories, as well as reduce administrative burden on the Centers for Medicare & Medicaid Services (CMS). Without Congressional action, about 800 laboratory test reimbursement rates will be reduced further than they already have been beginning January 31, 2026.

ACLA testimony

Susan Van Meter, President of the American Clinical Laboratory Association (ACLA) provided testimony before the subcommittee. She shared the following three significant challenges of the current law, Protecting Access to Medicare Act (PAMA):

· PAMA failed to use current and comprehensive market data representative of all three segments of the laboratory market to determine the Clinical Laboratory Fee Schedule (CLFS). CMS collected 2016 commercial market data from less than one percent (1,972) of the 261,524 clinical laboratories in the United States. Moreover, over representation of independent laboratories and underrepresentation of hospital outreach laboratories drove down CLFS rates.

· Medicare reductions under PAMA are far deeper than intended, which is an outgrowth of the incomplete market data. Current law allows for continued reductions of up to 15 percent annually in 2026, 2027, and 2028, despite the 10 percent cuts taken between 2018 and 2020. Medicare payments to laboratories were cut by nearly $4 billion between 2018 and 2020 — almost four times the Congressional Budget Office estimate. Further, the Medicare reductions have lowered many commercial market rates as private payors have based their rates on these.

· High administrative burden that requires laboratories to report each and every payment rate from each private payor for all 1,600 codes in the CLFS. The second data collection period was scheduled for the first half of 2019, but Congress has delayed the reporting in each year from 2020 to 2025. Without real Congressional action, on February 1, 2026, laboratories will be required to report private payor rates and volumes from 2019 and that data will be used to develop CLFS rates for 2027–2029. This old data would compound the issues at hand.

What is in the RESULTS Act

Reform the CLFS so payment rates are based on more representative commercial market data rather than the limited data set used under PAMA. CMS would obtain paid claims data from an independent, not-for-profit database that includes at least 50 billion fully paid claims from over 50 commercial payors and claims administrators to set CLFS rates based on private payor rates for widely available tests that are not advanced diagnostic laboratory tests (ADLTs).
Data collection and reporting for ADLTs, of which there are currently 19, would occur annually.
Clinical laboratories would no longer bear the burden of collecting and reporting payor rate date on widely available tests.
Data from 2027 would be reported in 2028 to reset Medicare rates in 2029. Future cycles would continue to ensure CLFS rates are based on current data. CLFS rates would be frozen at current levels for 2026–2028 to provide time to establish the new RESULTS framework.
Payment reductions would be limited to 5 percent a year, providing stability to the Medicare program.

Subcommittee supportive

Several members of Congress asked thoughtful questions and expressed support for the RESULTS Act, such as the following:

Rep. Gus Bilirakis (R-FL) said, “Strong clinical laboratories are vital to delivering high-quality care, especially for seniors who depend on timely testing to maintain their health.”
Rep. John Joyce (R-PA) said, “As a doctor, I know firsthand that accurate diagnostic testing is critical for precise patient care and that is why I strongly support the RESULTS Act to improve patient access to these necessary services. This is bipartisan legislation and it provides for stability and it provides for predictability and it ensures that CMS has comprehensive cost data for the market-based Medicare payment structure that was originally intended under PAMA for clinical laboratory services. Since the passage of PAMA, we have seen drastic cuts in reimbursement for lab tests with cuts as high as 30% from previous rates. These cuts across the board impact testing for everything from a skin biopsy to a complete blood count. This under-reimbursement is a dire threat to access for seniors across our country, and there are more cuts slated to occur if we in Congress fail to act.”
Rep Thomas Kean (R-NJ) said, “In New Jersey, there are over 2,300 laboratories. In my district, there are over 200.” He asked Ms. Van Meter to articulate the urgency for reform needed for Medicare’s clinical laboratory fee schedule.
Democratic full committee and subcommittee ranking members Rep. Frank Pallone (D-NJ) and Rep. Diana DeGette (D-CO) acknowledged the bipartisan support for the RESULTS Act.

Summary — What you can expect next

Subcommittee members have ten business days (January 23) to submit additional written questions for the record to the witness, Susan Van Meter. She was asked to respond promptly to any questions received.
Energy & Commerce Committee leadership decides whether to mark up the bill (that is propose amendments, debate language, formally vote to approve a revised version).