Medicare Advisory Panel Meets Today and Tomorrow to Help Set 2027 Payment Rates for New Diagnostic Lab Tests

Federal regulators and a public advisory panel are meeting today and tomorrow to recommend how Medicare should pay for new clinical diagnostic laboratory tests that do not yet have established payment rates.

Each year, laboratories bring new tests to market, from genetic screens to specialized pathology panels. For each new or substantially revised test, Medicare assigns a payment rate using one of two methods. If the test closely resembles an existing covered test, CMS may crosswalk the payment, setting a rate based on the comparable procedure. If no close comparison exists, CMS uses a gapfilling process in which each of Medicare's regional billing contractors independently sets a preliminary rate, and CMS finalizes a national rate the following year.

Today's meeting of the Advisory Panel on Clinical Diagnostic Laboratory Tests focuses on tests for which CMS received no usable market pricing data during the most recent reporting period, which ended July 31, 2026. The public and the panel may present evidence and recommendations on the appropriate payment method for each such test.

After the meeting, CMS plans to post its proposed payment determinations in late September 2026. A comment period follows. Final rates for 2027 are set in November and take effect January 1, 2027.

The payment level Medicare assigns to a new test affects whether laboratories offer it broadly, which in turn affects whether Medicare beneficiaries can access it without significant out-of-pocket costs. Tests assigned low preliminary rates through gapfilling may be offered by fewer labs or in fewer geographic areas.