PAMA 2027 Update: Lab Rate Cuts and the RESULTS Act

Updated November 2026. PAMA reporting closed July 31 and CMS has posted preliminary 2027 rates. This review now covers where rates stand, where the RESULTS Act stands, and what labs should fix before January 1.

The PAMA reporting window closed on July 31, 2026. On September 21, CMS used that data to post preliminary 2027 Clinical Laboratory Fee Schedule (CLFS) rates. Final rates are expected this month and take effect January 1, 2027.

The short version: the cuts are real, they are bigger than most labs planned for, and for many tests they last three years, not one.

Where 2027 Lab Rates Stand Now

According to the CMS fact sheet, private payor data was reported for 1,528 of 1,947 CLFS codes. The weighted medians for those codes came in about 16% below 2026 Medicare rates on average.

• Data used: commercial payments from January 1 to June 30, 2025, reported by more than 6,300 labs
• 2027 cut: 775 tests take the maximum 15% reduction on January 1
• The cap is per year, not total: no test can drop more than 15% a year in 2027, 2028 or 2029
• Molecular and genomic tests show some of the widest gaps between Medicare and commercial rates

That third point is the one most labs miss. If a test's commercial median sits 30% below today's Medicare rate, it does not take one 30% hit. It takes 15% in 2027, then keeps falling in 2028 and 2029 until it reaches the median. Budget for three years, not one.

Want to see this for your own test menu? Read How to Model Your Lab's 2027 Medicare Rate Exposure for a step-by-step way to size it by CPT code.

Where the RESULTS Act Stands Now

The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, H.R. 5269 and S. 2761, is the permanent PAMA fix the lab industry is backing. It replaced SALSA as the main reform bill in September 2025.

As of November 2026, it has more than 135 bipartisan cosponsors and has had a legislative hearing, but it has not passed. Supporters are pushing to attach it to a year-end spending package. If Congress does not act before December 31, the 2027 cuts take effect as scheduled.

If it passes, the RESULTS Act would:

• Freeze rates at 2026 levels during the transition, canceling the 2027 cuts
• Replace lab self-reporting with an independent, not-for-profit commercial claims database
• Cap future cuts at 5% a year, down from 15%
• Exclude Medicaid managed care rates from the calculation
• Reset rates every four years, starting with 2027 data

Congress has stepped in to delay PAMA cuts seven times. It may do so again. But a delay is not a plan, and labs that wait for one lose weeks they could spend fixing what they control.

How We Got Here

PAMA, the Protecting Access to Medicare Act of 2014, ties Medicare lab rates to what commercial payors pay. The first data cycle captured fewer than 1% of labs, mostly large reference labs, and left out most hospital outreach labs and physician office labs.

The result was rates set too low. Labs took up to 10% cuts each year from 2018 through 2020, nearly $4 billion in lost reimbursement. Common tests like the CBC, basic metabolic panel and lipid panel have seen cumulative cuts of 30% or more.

The Consolidated Appropriations Act, 2026 blocked cuts through December 31, 2026 and replaced the old 2019 data with 2025 data. That bought one year. The 2027 rates are what came out of it.

What Labs Should Do Before January 1

You cannot change the fee schedule. You can change how much of it you actually collect. Use the next eight weeks on the parts of your revenue cycle you control.

1. Run your top codes against the preliminary rates.
Rank your Medicare codes by dollars, not volume. Apply the preliminary rate and flag every code facing the full 15% cut. Model 2028 and 2029 for those codes too.

2. Check your commercial contracts.
If a payor pays a percentage of the Medicare fee schedule, the cut follows you there. Find those contracts now and plan to renegotiate.

3. Know your denial rate by payor and reason code.
The benchmark is under 5%. Every denied claim costs you the full test value, and a 15% rate cut leaves less margin to absorb it.

4. Tighten front-end data and medical necessity.
Eligibility errors, missing ABNs and diagnosis codes that do not meet the LCD are the most preventable denials in lab billing. Fix them at the order, not after the denial.

5. Look at your billing technology.
Lab billing needs line-level LCD and NCD checks before a claim goes out. ADS clients run a nearly 99% first-pass clean claim rate with laboratory billing software and lab RCM built for that.

The Bottom Line

Reporting is done, preliminary rates are out and final rates land this month. The RESULTS Act could still stop the 2027 cuts, but it has not passed yet.

The labs that come through 2027 in the best shape will be the ones that knew their exposure early and closed their revenue leaks while there was still time.

Source: CMS, Preliminary CY 2027 Medicare CLFS Payment Rates fact sheet (September 21, 2026).