Header: PAMA Cycle Delayed to 2027, With New Base Year 2025
Background
PAMA is legislation passed in 2014, one part of which planned for the Clinical Laboratory Fee Schedule to be repriced every 3 years, based on surveys of payor prices in the insured marketplace. However, the triennial process only happened once - when payments from 2016 were surveyed in 2017 to set a new fee schedule in 2018. The survey has been delayed annually since 2020. This means 2019 data was frozen from 2020 reporting, and frozen from 2021 reporting, 2022 reporting, etc.
What's New
On February 3, 2026, the new budget bill gave new PAMA benchmarkets. The next reporting period will be in 1Q2027, reporting data from 1H2025, to reset a new trienniel schedule for 2028, 2029, and 2030.
The base year has been updated from 2019 to 2025. This means hundreds of "new" PLA codes (from 2019 to 2025) will get repriced in the "next" (rather than second-next) PAMA cycle.
The New Future
The plan would be, for data from 2029 to be reported in 2030 for a new schedule in 2031, 2032, 2033.
For More
See news at ACLA. ACLA continues to seek a larger-scale legislative fix, currently as legislation titled "RESULTS."