Medicare Meeting on 2027 Lab Test Payment Codes
Published Date: 5/1/2026
Notice
Summary
Medicare is hosting a public meeting on June 10, 2026, to talk about new and updated lab test codes that affect how much Medicare pays for these tests in 2027. Labs, doctors, and anyone interested can share their thoughts and data before May 29, 2026. This meeting helps decide fair payments and could impact lab test costs and Medicare budgets next year.
Analyzed Economic Effects
4 provisions identified: 1 benefits, 1 costs, 2 mixed.
How Medicare Will Price New Lab Tests
Medicare will set payment amounts for new or substantially revised clinical diagnostic laboratory test (CDLT) HCPCS codes for calendar year 2027 using one of two methods: "crosswalking" (pricing the new test comparable to existing tests) or "gapfilling" (if no comparable test exists). These methods determine how much Medicare will pay for those lab tests in 2027.
Gapfilling: Local First-Year Payments, Median Year Two
When gapfilling is used, each Medicare Administrative Contractor (MAC) sets a Part B geographic-area payment amount for the new test in the first year using sources like charges, test costs, and other payers. In the second year, Medicare pays the test code at the median of those MAC-specific amounts.
Limits on Reconsideration for Reconsidered Codes
The notice states that final determinations for reconsidered codes are not subject to further reconsideration. For final determinations on new test codes, the public may request reconsideration of the basis and amount of payment under Sec. 414.509.
Deadlines and Opportunity To Comment
CMS will hold a hybrid public meeting on June 10, 2026, and requires presenters and written comments to be submitted by May 29, 2026 at 5:00 p.m. E.D.T. CMS plans to publish proposed determinations by early September 2026 (with comments due in October 2026) and to post final determinations in November 2026.
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