CMS has released a new clin lab fee schedule for 2027-2028-2029. Price cuts were common, based on reported private payer pricing data. (Genomeweb here, HC Dive here.)
CMS released Excel files of roughly 7M claims (999,999 rows x 7 pages). Find the data on this page under the header "CY 2027 Information" which includes preliminary data aka raw data and preliminary medians aka new fee schedule.
CMS does not release data for sole source tests or for tests with less than 10 uses.
Charting 81455, 81456
I took a deep dive on codes 81455 (51+ tumor genes, DNA only or DNA+RNA) and code 81456 (51+ tumor genes, RNA only).
For 81455, there were 19,088 price points submitted, across 1669 individual data rows. For 81456, there were 14,731 price points submitted, but across only 526 individidual data rows.
New pricing for 81455 fell only $58, from $2919 to $2861. Price for 81456 is unchnaged in 2027 ($2919).
The distribution of private payer prices shows a tall peak acound the CMS fee schedule price, a prominent drift to the left (lower prices), and a very thin tail up to super-high prices (e.g. $15,000).
The AI Bar Charts
Here below are the bar charts, after binning the data in $500 increments. For both tables below, click to enlarge. For a zip file of the input and output data here.
- Group prices into uniform $500 bins: $0 to under $500, $500 to under $1,000, and so on through $14,500 to under $15,000. Add a final bin for $15,000 and above.
- Each bin includes its lower boundary and excludes its upper boundary.
- For each bin, sum the reported number of services—not the number of rows or distinct prices.
- For example, 5 services at $600 plus 2 services at $700 contribute 7 services to the $500–$999 bin.
- Display the price bins in ascending order on the X-axis and the total number of services in each bin on the Y-axis. Include bins with zero services.
- Verify that the sum of all bin totals equals the total number of services in the source data.
