We're gearing up for PAMA cycle II, CMS will release millions of lines of data in August or September 2026, in preparation for the new CLFS fee schedule in 2027.
Here's a look back at some of the wild data results in 2017.
https://www.discoveriesinhealthpolicy.com/2017/09/pama-raw-data-provides-unprecedented.html
Here's one panel from the 2017 blog.
Eg BRCA pricing ran from $1000 to $3220 (without mentioning outliers). I suspect the peak around $3000 was legacy 2014-forward Myriad BRCA sole source pricing, and the range around $1700-2000 was newer entrants contracting to a fraction like 70% or 80% of the CLFS at the time.
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Cms.data.gov still has a web page that takes you to cloud data for 2017 PAMA CLFS pricing, but it's hard to find the link. Help??
Yes — CMS hides the important link a bit.
The CMS CLFS landing page still has it near the bottom under “For more information” as:
“View the CLFS Applicable Raw Data File (from 2017 reporting)”
https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/medicare-clinical-laboratory-fee-schedule-private-payer-rates-and-volumes
CMS describes the current CLFS as based on PAMA private-payor-rate reporting and says the 2017 reporting used the January 1, 2016–June 30, 2016 data collection period; that same period still drives 2020–2026 CLFS rates because later statutory delays postponed new reporting effects. (CMS)
The easier direct CSV link, [Excel] from the federal data.gov catalog, is:
Data.gov also lists the API endpoint:
https://data.cms.gov/data-api/v1/dataset/0e57f57d-0acc-4c9c-8f8c-973e3f4a3c4b/data
The dataset title is “Medicare Clinical Laboratory Fee Schedule Private Payer Rates and Volumes.” Data.gov describes it as raw data from applicable laboratories reporting private payor rates and associated volumes for CLFS tests, and it lists the CSV download URL above. (catalog.data.gov)
