Recently Released CLFS Data Reveal Large Differences in Test Volume by Laboratory Setting

 The Centers for Medicare and Medicaid Services (CMS) released a report on Oct. 20 detailing significant differences in the share of reported test volume in different laboratory settings. 

The 2026 Private Payor Data Report is used to determine preliminary calendar year 2027 Clinical Laboratory Fee Schedule (CLFS). The data revealed that hospital and physician office laboratories cover 9.9 and 11.3 percent of reported test volume, respectively, while independent laboratories cover 76.5 percent.

The share of total CLFS spending among hospital, physician office, and independent laboratories reporting private payer data follows a similar trend. Hospital and physician office laboratories accounted for 47 and 33.1 percent, respectively, while independent labs accounted for 80.8 percent of total CLFS spending in 2025.

The College of American Pathologists recently expressed concerns that the data used to establish 2027 CLFS rates was not comprehensive or representative of the laboratory market. These concerns echo those raised by the American Clinical Laboratory Association in September.

Both organizations are calling for passage of the RESULTS Act (H.R. 5269/S. 2761), which would reform how Medicare sets CLFS rates by providing CMS with comprehensive and representative commercial claims data. It would also reduce the reporting burden for laboratories.

A coalition of supporters for the bill met with legislators on Oct. 20 to urge its passage in a year-end package. The advocates stressed the need for long-term reform to grant laboratories greater stability for investment in services and innovation.

Sources:

https://www.cms.gov/files/document/cy-2027-clfs-additional-summary-information-2026-private-payor-data-reporting-period.pdf

https://www.cap.org/advocacy-update/new-cms-data-raise-questions-about-laboratory-payment-rates/

https://www.acla.com/preliminary-medicare-laboratory-rates-based-on-incomplete-data-underscore-urgent-need-for-the-results-act/

https://www.cap.org/advocacy-update/cap-joins-results-act-push-on-capitol-hill/