How a Lab Test Loses Its Price in Three Business Days
Medicare's advisory panel voted a specific crosswalk price for 110 new lab codes on September 15 and 16. CMS posted its own preliminary determinations the following Monday, replacing the panel's price with gapfill on 20 of them, including $95,508 of recommended payment across eight codes the panel valued above $7,500 each. The comment window closes this month and CMS has not published the date.
If you bill a code that has no Medicare price yet, the only window you get to argue about next year's price is open right now.
It closes sometime this month. CMS has not said which day.
That is not an oversight anybody has to infer. The Federal Register notice announcing this cycle, published May 1, promises twice that "the specific date for the publication of the determinations on the CMS website, as well as the deadline for submitting comments regarding the determinations, will be published on the CMS website." The determinations are up. The date is not, and neither is the deadline. The file sits in the downloads list with no date beside it, on a page where the row directly below it reads "(Updated 12/10/2025)."
The only timestamp the artifact carries is its HTTP header: Monday, September 21, 2026, 19:53 GMT.
Which matters, because the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests met the Tuesday and Wednesday before that, September 15 and 16, and voted code by code on 110 new and reconsidered test codes. CMS posted what it intends to do instead three business days later.
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