Monday, September 28, 2026

The Distribution of PAMA Prices: Case Study 81455, 81456 (51 or more tumor genes)

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CMS has released a new clin lab fee schedule for 2027-2028-2029.   Price cuts were common, based on reported private payer pricing data.  (G...
Friday, September 25, 2026

LegislationWatch: ASAP (Alzheimer Tests), MAIA, PACA, PPA (all for Medicare Advantage Claims)

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 ALZHEIMER ON THE HILL On September 16, 2026, the House Ways and Means committee advanced a bipartisan Alzheimer bill , "Alzheimer'...

Very Brief Blog: John Warren Highlights "Genealogy of Pricing" as Key to Crosswalks

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In an excellent Linked In posting, CMS consultant John Warren emphasizes that you can't do crosswalks and gapfill decisions any more, wi...
Thursday, September 24, 2026

Cheat Sheet: The Six Publications About GRAIL (Released Concurrent with FDA Ad Comm)

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We just had the Ad Comm for GRAIL - whose stock nearly doubled from 9/17 to 9/24.  Market cap rising from $2.5B to $5.5B.   You'll be ex...

History Corner: The Origins of the Mismatched -26 and -TC Modifiers

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Part 1 Why Is the Professional Component “26,” but the Technical Component “TC”?  A Little CPT Archaeology [Article by: Chat GPT 6] [Part 1 ...

BCBS, NYT: Hospital AI Bills Battle Payer AI Denials!

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The headline was inevitable.  Hospital AI pumps out bigger better invoices.   Health insurer AI rolls up its sleeves and pumps out denials. ...

GRAIL's Day at FDA: The Most Detailed Report

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GRAIL has its day at FDA on September 23, 2026, with panelists voting in favor of the effectiveness and safety of Galleri. The FDA website i...
Tuesday, September 22, 2026

The July 2026 RFI on Modernizing CLIA: What Do Public Comments Say??

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 CMS issued a Request for Information (RFI) on modernizing CLIA in July 2026, with comments closing September 14, 2026.   See the comment se...
Monday, September 21, 2026

When Does MolDx Change Its Mind? The Prelude Papers

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When does MolDx change a non-coverage proposed LCD into a coverage final LCD? Famously, this happened once in the last few years, regarding ...

CMS Posts Cy2025 Part B National Utilization Data

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 CMS has posted CY 2025 National Part B utilization data as simple Excel files.  Find them here: https://www.cms.gov/data-research/statistic...

PAMA is Brutal on Top-End Kitted MoPath Tests

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 Here's a section quoted from my blog on PAMA Pricing 2027: Lesson: PAMA is brutal on kitted molecular tests Once again, PAMA Is brutal...

Public Comments on Physician Fee Schedule Proposals for CY2027

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CMS accepted comments on the proposed Physician Fee Schedule rules for 2027 until September 14, 2026. Comments are posted and searchable her...

CMS Posts "PAMA" Lab Fee Schedule for 2027 Forward

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 CMS has posted data on PAMA pricing for laboratory tests.   The private payor payment rates, effective in 1H2025, are used to set a new cli...
Wednesday, September 16, 2026

Can AI Get PAMA News From Investor Calls?

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I asked both CLAUDE and CHAT GPT to scan recent lab industry investor calls for PAMA news and predictions.   I include CLAUDE below; the two...

Very Brief Blog; Convergent Genomics Exits via Veracyte Acquisition

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  https://www.genomeweb.com/diagnostics/molecular/liquid-biopsy/gnw-veracyte-acquisition-convergent-genomics-20260915/ Here is the headline ...