Medicare is preparing to change how much it pays laboratories for bloodwork, urine tests, and other medical tests starting in 2027.
The Centers for Medicare & Medicaid Services (CMS) says the changes could save taxpayers approximately $1 billion every year.
But if you’re on Medicare, you may be wondering what this means for you. Will your blood tests cost more? Could your local laboratory stop accepting Medicare? Will you need to do anything differently?
Here’s the most important thing to know: These changes affect how Medicare pays laboratories, not how much money you receive in benefits.
CMS has not announced new charges for beneficiaries as part of this update, and the payment rates aren’t final yet.
Here’s what’s changing, when it could happen, and what Medicare beneficiaries should know.
What Is Medicare Changing in 2027?
On September 21, 2026, CMS released preliminary payment rates for the 2027 Clinical Laboratory Fee Schedule (CLFS).
The CLFS is the system Medicare uses to determine how much it pays laboratories for many diagnostic tests.
These include common services such as:
- Blood tests.
- Urine tests.
- Cholesterol testing.
- Blood chemistry panels.
- Certain tests for infections.
- Other covered clinical diagnostic laboratory services.
When your doctor orders a medically necessary laboratory test, Medicare generally pays the laboratory according to an established payment schedule.
CMS is now updating those payment amounts using information about what private health insurance companies pay for similar tests.
According to the official CMS announcement, Medicare has been paying approximately 16% more than private insurers for laboratory services included in its analysis.
CMS wants to bring Medicare payments more closely in line with those private insurance rates.
The agency estimates the changes could reduce federal spending by approximately $1 billion annually.
However, that doesn’t mean Medicare beneficiaries will receive $1 billion in refunds, rebates, or reduced medical bills.
The estimated savings come from Medicare paying laboratories less for certain services.
Why Is Medicare Changing Laboratory Payments?
The payment update is part of a federal law called the Protecting Access to Medicare Act of 2014 (PAMA).
Under PAMA, Medicare uses payment information reported by applicable laboratories to help determine reimbursement rates for clinical diagnostic tests.
The idea is to base Medicare’s payment amounts on what laboratories actually receive from private insurers.
In 2026, CMS collected updated private-payer payment information for the next rate-setting cycle.
The agency received data from 6,411 laboratories, representing a substantial increase from the previous reporting cycle in 2017.
CMS says participation increased by approximately 230%.
That expanded reporting includes more hospital laboratories, physician office laboratories, and independent laboratories.
The new data gives CMS a broader picture of what private insurers are paying for different laboratory tests.
Based on that information, the agency developed preliminary payment rates for 2027.
How Much Will Medicare Cut Laboratory Payments?
Not every laboratory test will receive the same payment adjustment.
Although CMS identified an average potential reduction of approximately 16%, that doesn’t mean every test will have its Medicare payment reduced by 16%.
In fact, some tests could receive higher payments.
According to the CMS fact sheet, the preliminary analysis shows:
| Payment Change | Number of Test Codes |
|---|---|
| Lower payment rates | 1,171 |
| No change | 169 |
| Higher payment rates | 186 |
These figures represent test codes with comparable private-payer data and existing Medicare rates.
They show that most of the affected tests could receive lower reimbursement rates, while some would remain unchanged or increase.
Which Types of Tests Could See the Biggest Changes?
CMS also examined how the preliminary rates differ across laboratory testing categories.
The estimated changes include:
| Laboratory Test Category | Potential Payment Change |
|---|---|
| Chemistry tests | -16% |
| Microbiology tests | -19.3% |
| Immunology tests | -19.3% |
| Molecular pathology tests | -22% |
| Genomic sequencing tests | -23% |
These are preliminary category-level comparisons, not guaranteed payment reductions for every individual test.
Actual payment changes will depend on the final rates and applicable federal limits.
For example, even if the underlying private-payer data suggests a larger reduction, Medicare generally cannot reduce payment for an individual test by more than 15% in a single year during the 2027–2029 phase-in period.
Can Medicare Cut Laboratory Payments by More Than 15%?
Federal law limits how quickly Medicare can reduce certain laboratory payment rates.
Under the rules applicable to 2027 through 2029, the payment rate for an individual test cannot decrease by more than 15% in a single year compared with the previous year’s established rate.
This means some reductions will be phased in rather than implemented all at once.
For example, if Medicare currently pays $100 for a particular test, the annual reduction limit generally prevents that payment from dropping below $85 in the following year solely through this rate-setting process.
Additional reductions may occur in later years, subject to the applicable limits and payment rules.
This protection applies to what Medicare pays laboratories.
It does not mean beneficiaries will receive a 15% discount or that their personal medical expenses will decrease by that amount.
Will Medicare Beneficiaries Have to Pay More for Blood Tests?
CMS has not announced new beneficiary cost-sharing requirements as part of these preliminary laboratory payment changes.
For people with Original Medicare, many covered clinical diagnostic laboratory tests have no out-of-pocket cost.
According to Medicare’s coverage rules, you generally pay $0 for covered clinical diagnostic laboratory tests when they are medically necessary and ordered by an eligible healthcare provider.
These tests generally do not have a Part B deductible or coinsurance when they are covered and paid under the Clinical Laboratory Fee Schedule.
However, there are important exceptions to understand.
Not every test is automatically covered.
A test may need to meet Medicare’s medical necessity and other coverage requirements.
You may also owe money for other services provided during the same visit, even if the laboratory test itself is covered at no cost.
For example, a doctor’s office visit may have separate cost-sharing requirements.
What If You Have Medicare Advantage?
Medicare Advantage plans must cover medically necessary services covered by Original Medicare, but plan rules and cost-sharing arrangements can differ.
Depending on your plan and the type of test, you may need to use an in-network laboratory or follow other coverage requirements.
The new CMS laboratory payment announcement does not automatically change your Medicare Advantage plan’s benefits.
If you’re concerned about a specific test, contact your plan before the appointment to confirm coverage and any potential out-of-pocket costs.
Could These Changes Affect Access to Laboratory Testing?
This is one of the bigger questions surrounding the proposal.
When Medicare reduces the amount it pays healthcare providers, those providers may have concerns about whether the new rates adequately cover their costs.
Some laboratory companies and healthcare organizations have raised concerns about the potential financial impact of lower reimbursement rates.
Smaller laboratories and those serving communities with fewer healthcare options may be particularly sensitive to changes in payment.
However, that does not mean Medicare has announced laboratory closures or that your local laboratory will stop accepting Medicare in 2027.
Those are possible concerns about how payment changes could affect providers, not confirmed outcomes of the new rates.
For beneficiaries, the practical issue to watch is whether the laboratories they normally use continue providing covered services.
If you rely on a small or rural laboratory, you can ask whether it expects any changes to its Medicare services next year.
There’s no reason to assume you need to find a different laboratory simply because CMS released preliminary payment rates.
Are These Medicare Changes Final?
No. The rates announced September 21, 2026, are preliminary.
CMS released the proposed payment amounts and supporting data for public review before finalizing the 2027 fee schedule.
The agency has established the following timeline:
| Date | What Happens |
|---|---|
| September 21, 2026 | CMS publishes preliminary 2027 laboratory payment rates |
| October 21, 2026 | Public comment deadline |
| November 2026 | CMS expects to publish final payment rates |
| January 1, 2027 | Final 2027 rates are scheduled to take effect |
As of October 15, 2026, the public comment period is still open.
CMS may review feedback and supporting information before publishing the final rates.
The agency has also released preliminary payment determinations for certain newer laboratory tests and information about tests requiring specialized pricing methods.
Those materials have their own technical review and reconsideration procedures.
For most Medicare beneficiaries, the key date is January 1, 2027, when the finalized payment schedule is expected to take effect.
How to Submit a Public Comment Before October 21
CMS is accepting public comments on the preliminary 2027 Clinical Laboratory Fee Schedule.
If you want to share concerns about the proposed payment rates, particularly how they might affect access to laboratory services in your community, you can submit feedback before the deadline.
Public Comment Deadline: October 21, 2026
For comments on the preliminary 2027 payment rates, CMS directs submissions to:
CLFS_Annual_Public_Meeting@cms.hhs.gov
The agency also provides supporting payment data and additional instructions on its official website.
Visit the CMS Clinical Laboratory Fee Schedule page for the current materials.
CMS’s PAMA reporting and resources page also instructs commenters addressing the private-payer median data to include “median data” in the email subject line.
Different reconsideration requests may use different submission addresses, so check the instructions for the specific material you’re commenting on.
You don’t need to submit a comment to keep your Medicare coverage or continue receiving covered laboratory tests.
Participating in the comment process is optional.
Does This Change Medicaid or Marketplace Insurance?
This announcement specifically concerns Medicare’s Clinical Laboratory Fee Schedule.
It does not establish new Medicaid eligibility rules, change Medicaid benefits, or announce new cost-sharing requirements for Affordable Care Act Marketplace plans.
Medicaid and Marketplace plans have their own payment and coverage arrangements.
If you have Medicaid or a Marketplace plan, you should continue following your existing plan’s coverage rules unless your state or insurer announces a separate change.
Do You Need to Do Anything Right Now?
For most Medicare beneficiaries, no immediate action is required.
You do not need to enroll in a new program, complete an application, or contact Social Security because of this announcement.
You also don’t need to reschedule routine laboratory tests solely because CMS is reviewing payment rates.
If your doctor orders medically necessary bloodwork or other diagnostic testing, continue following your healthcare provider’s recommendations.
There are a few practical things you can do if you’re concerned:
- Check your coverage: Confirm whether your laboratory test is covered, particularly if you have Medicare Advantage.
- Use an appropriate laboratory: If your plan has network requirements, verify that your chosen laboratory participates.
- Review unexpected bills: If you receive a bill for a laboratory test you believed was covered, ask your provider or plan for an explanation.
- Watch for official updates: CMS expects to release final 2027 payment rates in November.
You can also contact Medicare at 1-800-MEDICARE (1-800-633-4227) if you have questions about coverage for a particular laboratory service.
What Happens Next?
CMS expects to publish the final 2027 Clinical Laboratory Fee Schedule in November 2026.
Those rates are scheduled to take effect on January 1, 2027.
The final amounts may differ from the preliminary figures after CMS reviews public comments and other relevant information.
Once the rates are finalized, laboratories will have more clarity about the payments they can expect for covered Medicare tests.
For beneficiaries, the most important thing to watch is whether any separate changes are announced that affect coverage, laboratory availability, or out-of-pocket costs.
At this point, CMS has not announced new beneficiary charges as part of this payment update.
Relief Recap
Medicare is preparing to update how much it pays laboratories for bloodwork, urine tests, and other clinical diagnostic services in 2027.
CMS says Medicare has been paying approximately 16% more than private insurers for laboratory services and estimates that the updated payment rates could save taxpayers $1 billion annually.
Most test codes with comparable data would receive lower payment rates, although some would stay the same or increase.
The reductions are limited to 15% per test per year through 2029, and the final rates are expected in November 2026.
The public comment deadline is October 21, 2026, and the new payment rates are scheduled to begin January 1, 2027.
Most importantly, these changes do not create a new Medicare application, reduce your Social Security check, or automatically increase what you pay for covered laboratory tests.
If you’re looking for ways to reduce your healthcare expenses now, check out our guide to 15 Free Medicare Services You Can Get Today.
You may already qualify for preventive care and screenings that can help you stay healthy without adding to your medical bills.
