Header: CMS still stores publicly available cloud data on lab test pricing surveyed in 2017 and representing CY2016.
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Congress and CMS are re-activating the PAMA reporting process. For reporting laboratories who had >$12500 in Medicare payments in 1H 2025, they will report data on all claims paid by commercial payors in 1H2025, and they will report in May-June-July 2025. See websites and announcements at CMS.
https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule/clfs-reporting
The prior survey reporting 1H2016, reported and posted in 2017. This set a new fee schedule for 2018 forward.
See the 2016/2017 Cloud Data
At the time, CMS published a gigantic cloud database of reported prices. I thought that was no longer available, but it seems it is. The data can be pretty interesting.
On this page:
https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs
see "CLFS Applicable Raw Data File from 2017 Reporting."
That sends you here:
For example, if you search 81211 (a popular BRCA code in 2016), you get 374 rows of data.
I wasn't sure how that squares with a contemporary old 2017 data file I havea for PAMA 81211, which has 2364 rows of pricing data for 81211. I think the current cloud data leaves out all price reporting with less than 10 units per line, and my old file with 2364 lines includes many lines with only 1 or 2 payments at that price. The overall shape of the data would be the same, just scaled down.
For example, the 2016 data I have (with 2364 lines) for BRCA 81211 shows a large price peak around $2900, which I assume reflect Myriad payments (this was not long after the BRCA Supreme Court case), and relatively few commercial payments at the CMS rate back then (around $2200) but another peak of payments around $1800, which was 85% of the CLFS at the time. So I inferred (this is just armchair guessing) that Myriad was cruising along with numerous legacy contracts in the $3000 range for BRCA 81211, while new entrants were entering the newly opened BRCA market often at 85% of the CLFS.
It was also notable that the thin tail of cheapest payments went below $100 and thin thin top end had the rare payment over $6000.
