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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2025

Announced on  | Last Modified on  | Project Number: OEI-09-26-00220
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare is the largest payer of clinical laboratory services in the United States. Medicare Part B covers most lab tests and pays 100 percent of allowable charges. The Protecting Access to Medicare Act of 2014 (PAMA), Pub. L. No. 113-93, requires the Centers for Medicare & Medicaid Services (CMS) to set payment rates for lab tests using current charges in the private health care market, under Title XVIII of the Social Security Act (PAMA, § 216(a)). On January 1, 2018, CMS began paying for lab tests under the new system mandated by PAMA. PAMA also requires OIG to publicly release an annual analysis of the top 25 laboratory tests by expenditures (Pub. L. No. 113-93 § 216(c)(2)(A)). In accordance with PAMA, we will publicly release an analysis of the top 25 laboratory tests by expenditures for 2025.

TIMELINE

  • April 15, 2026
    Announced
  • Today
    Office of Evaluation and Inspections In-Progress
  • Est FY2028
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Laboratories
Target Groups
-
Financial Groups
Medicare B