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LUGPA Policy Brief: Reforming the Medicare Clinical Laboratory Fee Schedule, The RESULTS Act

December 2025

Legislation has been introduced in Congress to reform how Medicare sets reimbursement rates for clinical laboratory tests. The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act aims to create a more stable, transparent, and accurate system for determining payment under the Medicare Clinical Laboratory Fee Schedule (CLFS). LUGPA supports Congressional efforts to ensure fair reimbursement and maintain patient access to essential diagnostic services.

The Medicare Clinical Laboratory Fee Schedule was restructured under the Protecting Access to Medicare Act (PAMA) of 2014 to more closely align payments with private-market rates. However, the data collection and reporting process used to set those rates has resulted in significant reductions in reimbursement for many laboratory tests, particularly those commonly performed in community and physician office settings.

Since 2018, Congress has taken several actions to delay additional payment cuts, acknowledging ongoing concerns about the accuracy and sustainability of the rate-setting process. Without additional action, reductions of up to 15% are scheduled to take effect on January 1, 2026, for hundreds of laboratory tests.

About the RESULTS Act

The RESULTS Act proposes a permanent solution to stabilize the CLFS and modernize the process of determining test reimbursement.

Key provisions include:

  • Independent Data Use: CMS would use data from an independent commercial claims database to set rates for widely available tests, ensuring they reflect broader market trends.
  • Simplified Reporting: For tests that are not widely available, such as those for rare diseases, laboratories would continue to provide commercial rate data directly to CMS.
  • Reduced Administrative Burden: The legislation would extend the rate-setting cycle to every four years, easing reporting demands on laboratories and the agency.
  • Payment Stability: Annual payment reductions would be limited, and Medicaid managed care rates—often lower than market averages—would be excluded from the data used to calculate reimbursement levels.

Impact on Independent Practices

Accurate reimbursement for laboratory testing is critical to the delivery of timely and effective patient care in independent urology practices. Tests such as prostate-specific antigen (PSA) screenings,  urinalysis, and other diagnostic assays are essential tools for managing complex conditions and coordinating care within the office setting.

Sustained payment reductions under the current system could:

  • Limit access to in-office testing services for Medicare beneficiaries.
  • Increase administrative strain on smaller practices.
  • Shift diagnostic services to higher-cost hospital settings, reducing efficiency and convenience for patients.

The RESULTS Act seeks to address these concerns by providing a fairer, more predictable payment framework that better supports patient care and operational stability.

LUGPA’s Position

LUGPA supports reforms that ensure Medicare reimbursement for laboratory testing accurately reflects the true costs of providing care in physician practices. The RESULTS Act represents a constructive step toward long-term payment stability, reduced administrative burden, and improved patient access to diagnostic services in the community setting.