OIG Review of Medicare Clinical Diagnostic Laboratory Test Payments 2025
Summary
HHS OIG announced a new work plan project (OEI-09-26-00220) to conduct an annual analysis of the top 25 laboratory tests by Medicare expenditures for 2025, as required by the Protecting Access to Medicare Act of 2014 (PAMA). The review is currently in-progress under the Office of Evaluation and Inspections, with an estimated completion date of fiscal year 2028. CMS began paying for lab tests under the PAMA-mandated system on January 1, 2018, using current charges in the private healthcare market under Title XVIII of the Social Security Act.
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GovPing monitors HHS OIG Work Plan for new healthcare & life sciences regulatory changes. Every update since tracking began is archived, classified, and available as free RSS or email alerts — 9 changes logged to date.
What changed
HHS OIG has added a new evaluation project to its work plan, OEI-09-26-00220, which will publicly release an analysis of the top 25 laboratory tests by Medicare Part B expenditures for 2025, as mandated by PAMA § 216(c)(2)(A). The project was announced on April 15, 2026 and is currently in-progress.
Affected parties—including clinical laboratories, hospital laboratories, and independent labs that bill Medicare Part B for diagnostic tests—should monitor OIG findings, as the annual expenditure analysis may inform policy discussions around PAMA payment rate adequacy. This is an informational review rather than an enforcement action; no immediate compliance obligations arise from this announcement.
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Apr 22, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
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Medicare Payments for Clinical Diagnostic Laboratory Tests in 2025
Announced on
04/15/2026
| Last Modified on
04/15/2026
| Project Number: OEI-09-26-00220
Status Active Agency Centers for Medicare and Medicaid Services
OBJECTIVE
Medicare is the largest payer of clinical laboratory services in the United States. Medicare Part B covers most lab tests and pays 100 percent of allowable charges. The Protecting Access to Medicare Act of 2014 (PAMA), Pub. L. No. 113-93, requires the Centers for Medicare & Medicaid Services (CMS) to set payment rates for lab tests using current charges in the private health care market, under Title XVIII of the Social Security Act (PAMA, § 216(a)). On January 1, 2018, CMS began paying for lab tests under the new system mandated by PAMA. PAMA also requires OIG to publicly release an annual analysis of the top 25 laboratory tests by expenditures (Pub. L. No. 113-93 § 216(c)(2)(A)). In accordance with PAMA, we will publicly release an analysis of the top 25 laboratory tests by expenditures for 2025.
TIMELINE
- April 15, 2026 Announced
- Today Office of Evaluation and Inspections In-Progress
- Est FY2028 Estimated Fiscal Year for Project Completion Work Plan Type Office of Evaluation and Inspections HHS Agencies Centers for Medicare and Medicaid Services Issue Areas Laboratories Target Groups - Financial Groups Medicare B
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