News
- CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1B Annually
- Clinical Laboratory Fee Schedule: Submit Comments & Reconsideration Requests by October 21
- Connecticut: $50M to Optimize Care Delivery & Improve Rural Hospital Infrastructure
- Missouri: More Than $45M to Upgrade Rural Hospitals, Connect Families to Rapid Psychiatric Consultations and Maternal Care & Train More EMS Professionals
- New Mexico: $74M to Expand Specialty, Maternal & Behavioral Health Care
- South Carolina: $167M to Build Rural Care Sites, Upgrade Health Technology & Strengthen Prevention
- CMS Announces Participants in Landmark Medicaid Drug Payment Model to Bring Down Drug Costs for Most Vulnerable Americans
Compliance
Claims, Pricers & Codes
Events
News
CMS Announces New Preliminary Medicare Payment Rates for Laboratory Services, Saving Taxpayers an Estimated $1B Annually
To stop payments above market rates for laboratory services in Medicare and save taxpayer dollars, CMS plans to better align the 2027 Clinical Laboratory Fee Schedule (CLFS) rates with private sector payment rates, saving an estimated $1 billion annually. While final rates won’t be released until later this year, CMS is releasing the data and information used to determine the preliminary 2027 Medicare payment rates for laboratory services showing that Medicare has been paying about 16% more for laboratory services than private payors. Basing Medicare’s rates on those paid by the private sector helps ensure that Medicare is paying appropriate amounts for laboratory tests and protecting taxpayer dollars.
The public has until October 21, 2026, to review and submit comments on the preliminary CY 2027 CLFS rates (ZIP) and supporting data files (ZIP). Written comments should be submitted electronically to CLFS_Annual_Public_Meeting@cms.hhs.gov.
More Information:
- Full press release
- Fact sheet
- CLFS webpage
Clinical Laboratory Fee Schedule: Submit Comments & Reconsideration Requests by October 21
Get the latest payment information on the Clinical Laboratory Fee Schedule (CLFS), and find out how to comment or request a reconsideration by October 21, 2026:
- CY 2027 preliminary determination for new tests (ZIP): Submit comments to CLFS_Annual_Public_Meeting@cms.hhs.gov
- Final Medicare Administrative Contractor 2026 gapfill recommendations for CY 2027 (ZIP):
- Submit payment reconsideration requests to CLFS_Inquiries@cms.hhs.gov
- Once we post the final, complete CY 2027 CLFS fee schedule, the gapfilled payment amount is final
Visit the CLFS Annual Public Meetings webpage for more information on the annual rate setting process.
Connecticut: $50M to Optimize Care Delivery & Improve Rural Hospital Infrastructure
This federal investment will help rural hospitals upgrade equipment, renovate facilities, enhance care delivery, and support long-term sustainability across rural Connecticut.
The Trump Administration announced that a $50 million investment is being delivered to improve rural health and expand access to high-quality care for Connecticut residents through the federal Rural Health Transformation Program. This funding will help 4 rural hospital systems modernize facilities, expand service capacity, and stabilize essential health care infrastructure to better serve rural Connecticut communities.
Read the full press release.
Missouri: More Than $45M to Upgrade Rural Hospitals, Connect Families to Rapid Psychiatric Consultations and Maternal Care & Train More EMS Professionals
This federal investment will upgrade rural hospitals, connect providers with behavioral and maternal health specialists, and grow the emergency care workforce in rural Missouri.
The Trump Administration announced that more than $45 million in Rural Health Transformation Program funding is being delivered to support rural health care for Missouri residents. This investment will support hospital infrastructure improvements, expand behavioral and maternal health care access, and strengthen the rural emergency medical services workforce.
Read the full press release.
New Mexico: $74M to Expand Specialty, Maternal & Behavioral Health Care
This federal investment will establish regional hubs to bring more high-quality care closer to rural, frontier, and tribal communities.
The Trump Administration announced that a $74 million investment is being delivered to improve access to health care for New Mexicans through the federal Rural Health Transformation Program (RHTP). This investment will support 6 Regional Hub Organizations lead Healthy Horizons, one part of New Mexico's 5-year RHTP strategy that supports better access to specialty, maternal, behavioral health, chronic disease, and other health care services in rural, frontier, and tribal communities. The Regional Hub Organizations will begin this work by coordinating with local providers and community partners to identify needs, set priorities, and develop plans that bring specialty, maternal, behavioral health, and other health care services closer to home for rural New Mexicans.
Read the full press release.
South Carolina: $167M to Build Rural Care Sites, Upgrade Health Technology & Strengthen Prevention
This federal investment will support telehealth, remote monitoring, mobile care, cybersecurity upgrades, and new technology to improve maternal and behavioral health care.
The Trump Administration announced that a $167 million investment is being delivered to expand local access, modernize technology and infrastructure, improve prevention, and strengthen workforce capacity for South Carolinians through the federal Rural Health Transformation Program. This investment will give residents more ways to access primary care, maternal and infant health, pediatrics, wellness, and behavioral health through new and modernized care locations, mobile units, telehealth, and other health care technologies, such as local 24-hour pharmacy kiosks.
Read the full press release.
CMS Announces Participants in Landmark Medicaid Drug Payment Model to Bring Down Drug Costs for Most Vulnerable Americans
CMS is working to end skyrocketing drug costs as the agency announces that all 50 states, plus the District of Columbia and Puerto Rico, have applied to participate in an initiative which provides most-favored-nation pricing for certain prescription drugs to people with Medicaid. Forty states and Puerto Rico have already signed agreements to participate in this historic program that will lower Medicaid drug costs to what other countries pay, saving an estimated $64.3 billion in taxpayer dollars over the next 10 years, while preserving or enhancing beneficiaries’ quality of care.
The GENErating cost Reductions fOr U.S. Medicaid (GENEROUS) Model is a landmark CMS Innovation Center initiative designed to not only lower drug spending in Medicaid but also improve quality of care and health outcomes by increasing access to critical medications and strengthening the Medicaid program overall.
More Information:
- Full press release
- GENEROUS Model webpage
Compliance
Toileting Aids: Prevent Claim Denials
In 2024, the improper payment rate for commodes, bed pans, and urinals was 32.6%, with a projected improper payment amount of $2.5 million. Learn how to bill correctly for these services. Review the Toileting Aids provider compliance tip for more information, including:
- Denial reasons and how to prevent them
- Documentation requirements
Claims, Pricers & Codes
Medicare Part B Drug Pricing Files & Revisions: October Update
Learn about quarterly updates to the following average sales price and not otherwise classified pricing files:
- October 2026
- July 2026
- April 2026
- January 2026
- October 2025
See the instruction to your Medicare Administrative Contractor (PDF).
Events
Inpatient Rehabilitation Facility FY 2027 Final Rule Webinar – September 29
Tuesday, September 29 from 1–2 pm ET
Register for this webinar.
Review FY 2027 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) final rule policies and related Medicare coverage updates, including:
- Starting required therapy treatments and evaluations within the 36-hour timeframe
- Timing and participation of initial interdisciplinary team meeting
This webinar will help IRF providers:
- Understand finalized policies
- Support consistent application of coverage requirements
- Reduce the risk of documentation and billing errors
More Information:
- Get event materials on the IRF PPS Final Rule webpage
- Submit questions about webinar logistics, webinar materials, or webinar content to IRFCoverage@cms.hhs.gov
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