Congress targets steadier Medicare lab test payments by using private claims data and public rate explanations

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Introduced in House

New Medicare rules are issued for data collection periods starting in 2027

Labs and data partners get updated instructions for what counts as the “final payment rate,” what gets excluded (like denied or recouped payments), and how Medicare will collect data going forward.

New definition of “applicable information” begins for data collection periods starting in 2027

The prices used to set Medicare lab payments focus on the last (final) amount paid, not temporary or disputed amounts, which may change future Medicare payment rates for some tests.

Next scheduled lab reporting window opens (as updated in the bill)

Labs that must report data would do so during this window, which feeds into future Medicare payment updates.

Medicare begins using the contracted claims database for widely available common lab tests

For many high-volume tests done by lots of labs, Medicare can calculate market-based rates using claims data instead of depending only on labs’ self-reported private prices.

Limits on how much certain lab payments can be cut tighten to 5% per year starting in 2029

This can reduce the chance of big year-to-year payment drops for some tests, which may help labs plan staffing and keep services available to Medicare patients.