The 2027 Lab Payment Cuts: Your Last Days to Be Heard (Comment by Oct 21)
Last week we covered CMS's proposed 2027 Clinical Laboratory Fee Schedule cuts and the bipartisan RESULTS Act pushing back. Here's the development that makes it urgent: the comment window closes Wednesday, October 21, 2026 — two days from today.
What's on the table
CMS published preliminary 2027 CLFS rates on September 21, and laboratories have had 30 days to review and comment. The agency is accepting written comments electronically at CLFS_Annual_Public_Meeting@cms.hhs.gov. (CMS fact sheet)
The headline numbers haven't moved: of 1,528 codes with private-payer data, 1,171 came in below 2026 Medicare rates. Gene sequencing is down 23%, molecular pathology 22%, microbiology and immunology 19.3% each, chemistry 16%. The newest science takes the deepest cut — genomic sequencing and molecular pathology lead the reductions while proprietary lab analyses face only 2.4% — and ASCP's own analysis found 12 of the 25 highest-spending CLFS tests face the maximum 15% cut. With OIG putting total Medicare lab spending at $8.4 billion and the top 25 tests at nearly half of it, these aren't marginal codes. (Becker's; ASCP) But here's the number that matters most for planning: by law, Medicare cannot cut any test more than 15% per year through 2029 — which means tests priced far below current rates face several years of cuts in a row, not a single adjustment. In practice, the cap turns one cut into two: codes facing 22–23% reductions won't reach their new payment level until 2028, not 2027. (CMS press release; Synopulse)
The data fight: who actually reported?
This is where labs have the strongest argument — and where the RESULTS Act gets its teeth. The private-payer medians come from 6,411 reporting labs, and the single largest group was physician office labs: 3,262 of them, more than hospital labs (875) and independent labs (775) combined. Independent labs say the data doesn't represent the broader commercial market — ACLA argues the original rate-setting method already contributed to nearly $4 billion in cuts from 2018 through 2020. (Becker's analysis; Forvis Mazars summary)
The RESULTS Act would replace the current data process with an independent commercial claims database — the fix for exactly this problem. ASCP and other laboratory organizations are urging Congress to act, and ASCP has an active Action Alert for members. (ASCP ePolicy, October 2026) Industry groups are now pushing to attach the RESULTS Act to an end-of-year healthcare package, and analysts note Congress has delayed these cuts before — which is exactly why the comment window matters now. (industry report)
What labs should do before Oct 21
1. Comment to CMS now. The argument with the most traction: the weighted medians are driven by physician-office reporting and don't reflect the broader lab market. Comments go to CLFS_Annual_Public_Meeting@cms.hhs.gov by October 21.
2. Write Congress. ASCP's eAdvocacy Center has a pre-written letter supporting the RESULTS Act, which would freeze rates at 2026 levels for 2027–2028 and fix the data process. (StopLabCuts.org)
3. Model the multi-year hit. With the 15%-per-year cap through 2029, your worst-affected tests compound. Run your high-volume codes against the preliminary medians now — before CMS finalizes rates in November.
4. Treat billing accuracy as revenue defense. Whatever Congress does, reimbursement pressure is moving one direction. Medical-necessity documentation that matches the diagnosis, LCD/NCD checks before submission, clean claims the first time — every denied claim hurts more when rates shrink.
The bottom line
The cuts are preliminary and the comment window is still open — but only until Wednesday. After October 21, CMS finalizes in November and the rates go into effect January 1, 2027. If your lab has a view on the data, this is the week to use it. As CAP president Dr. Qihui "Jim" Zhai put it, "cuts of this scale threaten the stability of the laboratory infrastructure." (CLP)
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