PAMA lab price reporting, for CMS median rate-setting, has been frozen since 2019. Based on section 6226 of the February 3 federal budget, that is changing fast.
Labs will report 1H2025 commercial payment levels in May-June-July 2026. CMS will publish consolidated median prices in the fall, which will be active on January 1, 2027 for three years.
When a new PAMA price is lower than the current 2026 price, the 2026 price can fall by now more than 15% per year (until it matches the PAMA price sooner or later).
Track CMS instructions here:
https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule/clfs-reporting
Nerd Note
Some insights gleaned from the last cycle, 2017 data, short blog here.
