CMS posts preliminary CY 2027 CLFS rates: private-payor medians ~16% lower

On September 21, 2026, the Centers for Medicare & Medicaid Services published a fact sheet posting preliminary weighted-median private-payor rates for calendar year (CY) 2027 under the Clinical Laboratory Fee Schedule (CLFS). The companion press release says CMS is aligning most 2027 laboratory payments with private-sector rates and estimates about $1 billion in annual taxpayer savings if the approach holds through final rates. Both pages list publication as September 21, 2026 (schema datePublished 2026-09-21T08:00:00-04:00).

This is the second full Protecting Access to Medicare Act of 2014 (PAMA) data cycle for most clinical diagnostic laboratory tests. Congress delayed the second reporting round for years; the Consolidated Appropriations Act, 2026 set the windows CMS used here. These figures are preliminary. CMS is taking comments before it finalizes CY 2027 rates.

If your desk owns the lab chargemaster, CLFS file loads, or outreach-lab revenue, this is the annual rate story to put next to the quarterly PLA file you already handled in October 2026 CLFS CR 14569.

What CMS posted

CMS calculated weighted medians of private-payor rates (volume-weighted) and published preliminary payment rates with and without quality-control exclusions. Exclusions removed:

• Duplicate records where TIN, NPI, HCPCS code, payment rate, and volume (if greater than 1) exactly match another record
• Outlier records where the reported payment rate exceeds 100 times the CY 2026 CLFS payment rate for that test

CMS is asking whether that exclusion approach is appropriate for the final weighted medians.

Of the codes with a weighted median:

• 186 higher than the CY 2026 CLFS rate
• 169 equal to the CY 2026 CLFS rate
• 1,171 lower than the CY 2026 CLFS rate
• Two HCPCS codes have a weighted median but no comparable CY 2026 CLFS rate

CMS also says hospital labs rose from about 1.1% of reporting applicable labs in 2017 to about 13.6% in the 2026 reporting period, with total reporting laboratories up 230% overall (1,942 to 6,411).

Data windows CMS used

Reporting entities submit private-payor rates, volumes, and HCPCS codes for applicable laboratories. That is the PAMA “applicable information” feed behind the weighted medians, not a coding edit module and not a coverage NCD change.

Category-level potential changes

CMS published potential weighted rate changes by test category (fact sheet table):

Read these as preliminary category averages, not as your CDM line. Pull the HCPCS-level files from the CLFS page before you rebuild a fee schedule.

The 15% annual reduction cap

CLFS cuts do not drop to the private-payor median in one year when the gap is larger than the cap. The Consolidated Appropriations Act, 2026 amended section 1834A so that, for CY 2027 through 2029, payment for a test may not be reduced by more than 15% per year compared with the amount established for that test in the preceding year. There is no phase-in reduction in CY 2026 under that same statutory update (CMS CLFS page summary).

For a code whose private-payor median sits far below the CY 2026 rate, expect multi-year step-downs through 2029 unless finals change the math. Do not invent a 2027 unit price from the category average alone.

Comment window, no-data tests, and timing

• Comments: 30 days after publication. Written comments go to CLFS_Annual_Public_Meeting@cms.hhs.gov. CMS is releasing raw data for HCPCS codes reported by 10 or more reporting entities (subject to confidentiality rules in SSA § 1834A(a)(10) and 42 C.F.R. § 414.504(f)).
• Tests with no applicable information: CMS held a public meeting September 15 to 16, 2026 on crosswalk vs gapfill. The press release says those determinations will be published in early October with a separate 30-day comment period.
• Also published concurrently: preliminary crosswalk/gapfill determinations for new 2026 clinical diagnostic laboratory tests, and final MAC gapfill recommendations for lab tests new in 2025.
• Finals: CMS anticipates publishing final CY 2027 CLFS rates in November 2026.
• Effective: final rates take effect January 1, 2027.

What this is not

• Not the October 2026 quarterly CLFS/CLIA update (CR 14569) (PLA adds/deletes and QW rows).
• Not a CMS-HCC / V28 mapping change. CLFS rates price laboratory HCPCS; they do not assign an HCC. For model mapping use ICD-10 to HCC.
• Not a final fee schedule. Do not replace your live CY 2026 CLFS prices with preliminary 2027 medians on claims with dates of service before January 1, 2027.

Look up descriptors in the encoder after you load the official file. Compare related HCPCS options in Compare when a PLA vs chemistry path is unclear. Browse the desk feed on /news for companion lab and coverage items.