Medicare patients would get more stable access to lab tests through new payment rules and data collection.
This bill would change how Medicare pays for many common lab tests, aiming for more stable access for patients. It would shift how the government collects data on private insurance payments for these tests. An independent group would be used instead of individual labs for some. If this new data collection fails for certain tests, their payment would increase by the rate of inflation. It also would adjust limits on how much Medicare payments for lab tests can be reduced each year.
Today, Medicare payment rates for lab tests are based on private payor rates reported by individual labs. Payment reductions are capped at 10 percent through 2028. Medicaid managed care organization rates are generally excluded. After this bill, for many common lab tests (called 'widely available non-advanced diagnostic laboratory tests'), Medicare would collect payment data from a large, independent database starting January 1, 2028. Payment reductions would be capped at 10 percent through 2028, then 5 percent for 2029 and each year after. Medicaid managed care organization data could be included in the calculations starting January 1, 2028. If the independent data collection fails for 'widely available non-ADLT' tests, their payment would increase by the Consumer Price Index for all urban consumers.
HR 5269 · 119th Congress · September 10, 2025 · AI Summary by gemini-2.5-flash · 9/10
Sign in to see your representatives' phone numbers
74 filings mentioned this bill
Amounts reflect total quarterly lobbying spend reported to the Senate, not bill-specific spending. Source: Senate LDA filings.