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The RESULTS Act 2025 isn’t law yet, but it’s already forcing lab billing teams to think differently about next year. PAMA’s flawed payment formula, built on incomplete data from too few labs, has been cutting Medicare rates for years—nearly $4 billion in the first three years alone. This bill aims to fix that by capping annual cuts at 5%, extending reporting cycles, and shifting most rate-setting to an independent claims database instead of relying on self-reported data.
For now, the 2026 cuts are blocked thanks to a separate spending bill, so labs have some breathing room. But the real question is what happens in 2027. If the RESULTS Act passes, rates freeze through 2028 while a new system gets built. If it doesn’t, those 15% cuts could come right back.
Billing teams can’t afford to wait for Congress to decide. Smart labs are auditing their CLFS codes, running dual revenue forecasts, and getting their reporting data organized now. Because whether the bill passes or not, preparation beats panic every time.
Suppose your lab just finished a strong quarter, and then a letter from CMS lands on your desk warning of a 15% payment cut on hundreds of the tests you run every single day. That’s not a hypothetical. It’s been the reality hanging over clinical laboratories for years, thanks to a flawed payment formula buried inside a 2014 law. Now there’s a new bill on the table that promises to fix it, and it’s called the RESULTS Act 2025.
You’ve probably already heard it discussed in webinars and trade association emails. But what does it actually do? And more importantly, what should your billing team be doing about it right now, in 2026, while the bill is still working its way through Congress? Let’s discuss how the RESULTS Act impacts the revenue stream for laboratories, and how to manage lab RCM services to stay ahead of compliance.
The RESULTS Act, short for the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act of 2025, is bipartisan legislation (H.R. 5269 in the House and S. 2761 in the Senate) built to fix the way Medicare pays for clinical lab tests. It was introduced in September 2025 by Representatives Richard Hudson, Gus Bilirakis, Brian Fitzpatrick, Raja Krishnamoorthi, and Scott Peters, along with Senators Thom Tillis and Raphael Warnock.
Its whole purpose? Rewrite the badly broken rate-setting process under the Protecting Access to Medicare Act (PAMA) of 2014, which currently governs the Clinical Laboratory Fee Schedule (CLFS), before it triggers a wave of reimbursement cuts that could hit nearly 800 commonly ordered lab tests.
As of mid-2026, the bill hasn’t been signed into law yet. It’s still awaiting decision in committee, and it picked up real momentum after a House Energy and Commerce Health Subcommittee hearing in January 2026 showed strong support from both parties. Lawmakers are reportedly eyeing a spot for it in a year-end spending package, similar to how prior PAMA delays got passed. So, no, it isn’t final. But the direction is clear, and your billing operations need to be ready either way.
To understand why the RESULTS Act matters so much, you’ve got to know what led to it. PAMA was supposed to be a win for accuracy. It required “applicable laboratories” (independent labs, hospital outreach labs, and physician office labs) to report the private insurance rates they were paid, so CMS could set fair Medicare rates based on real market data.
Here’s why it didn’t work out: fewer than 1% of labs actually reported data during the first collection cycle. Independent labs, which negotiate lower private payer rates, made up the vast majority of what got reported, even though they represent roughly half of CLFS test volume. Hospital outreach labs and physician office labs, which typically get paid more by commercial insurers, were barely represented at all.
The result was a fee schedule built on skewed, incomplete data. A report by the College of American Pathologists notes that Medicare cut CLFS payments by nearly $4 billion in just the first three years of implementation. And because the law only requires “applicable labs” to report periodically, that same distorted picture has stuck around for almost a decade.
Here is something worth noting: According to the American Clinical Laboratory Association (ACLA) President Susan Van Meter, clinical laboratories provide the essential information individuals need to understand their own health and supply the test results that guide 70% of all medical decisions.
That’s not a small stat. According to it, most of the medical decisions rest on lab data, yet the payment system funding that work has been running on outdated numbers for years.
| Issue Under Current PAMA Rules | What the RESULTS Act Would Do |
|---|---|
| Rate cuts of up to 15% per year | Caps annual cuts at 5%, with no cap on increases |
| Reporting every 3 years, using stale data | Extends the cycle to every 4 years |
| Nearly all labs must report data | Only labs with "non-widely available tests" and ADLTs must report; widely available tests use an independent commercial claims database instead |
| Medicaid Managed Care rates included in calculations | Medicaid Managed Care rates excluded, since they aren't market-based |
| No appeal process for CMS-set rates | Allows administrative and judicial review of rates starting in 2029 |
| Rates based on outdated 2016–2019 commercial data | Freezes CLFS rates at 2025 levels for 2026–2028; new rates in 2029 based on 2027 data |
| Date | Update |
|---|---|
| September 2025 | RESULTS Act introduced in the House and Senate with bipartisan sponsors |
| January 2026 | House Energy and Commerce Health Subcommittee holds a hearing on the bill; bipartisan support noted |
| January 23–February 3, 2026 | Congress passes the Consolidated Appropriations Act, 2026, blocking the scheduled 15% CLFS cuts for the rest of 2026 and pushing the reporting deadline forward |
| May 1 – July 31, 2026 | Applicable labs must report private payor rate data collected from January through June 2025 (not the originally required 2019 data) |
| January 1, 2027 | New CLFS rates go into effect based on whatever data gets reported, unless the RESULTS Act is enacted first and changes the framework |
Let’s talk about what’s actually landing on billing managers’ desks right now.
Here’s a question worth asking directly: Does the RESULTS Act guarantee lab reimbursement won’t be cut in 2026? Yes, for 2026 specifically, cuts are already blocked under the Consolidated Appropriations Act, 2026, regardless of whether the RESULTS Act itself becomes law. The RESULTS Act’s real job is preventing the cuts from resuming afterward, in 2027 and beyond.
Independent reference labs, hospital outreach labs, and physician office labs (POLs) each experience different cuts when it comes to risk exposure.
If your billing operation serves a mix of these lab types, it’s worth running a risk assessment by facility type rather than treating your whole portfolio the same way. A large reference lab with a diversified payer mix can typically absorb short-term instability far better than a rural outreach lab running on a single hospital’s outpatient volume.
Here’s something that often gets overlooked in the broader PAMA conversation: molecular and genomic testing labs operate under a slightly different set of rules already, and the RESULTS Act would sharpen that distinction even further.
As per 42 CFR § 414.504 of the Electronic Code of Federal Regulations (eCFR), the high-complexity molecular tests that are established Advanced Diagnostic Laboratory Tests (ADLTs) are paid at list price initially and then must report data annually rather than every three or four years. Under the RESULTS Act, that annual reporting obligation for ADLTs stays in place, even as most other labs get relief from frequent reporting.
For labs running DEX Z-Code registered assays under MolDX, or navigating MAC-specific coverage policies for molecular diagnostics, that means billing accuracy and documentation standards remain just as demanding as ever, if not more so. Since these tests represent a part of what CMS requires direct reporting on, they’re likely to draw closer scrutiny precisely because they’re the exception rather than the rule.
Billing teams handling ADLT claims should keep documentation complete: medical necessity, prior authorization records, and Z-Code assignment all need to be clean and accurate to secure reimbursement.
It’s tempting to think of PAMA and the RESULTS Act as a “Medicare problem” that doesn’t touch commercial billing. That’s not quite right. A surprising number of commercial payer contracts, especially with regional and mid-sized insurers, use a percentage of the Medicare CLFS rate as a benchmark for their own lab fee schedules. When CLFS rates swing, commercial reimbursement can swing right along with them, sometimes with a lag of six to twelve months.
That means a lab that isn’t watching PAMA policy closely could get affected twice: once when Medicare rates shift, and again when commercial payers quietly reprice their own fee schedules to match. Smart revenue cycle teams rely on professional laboratory credentialing support to build a standing checklist and review commercial payer contract language for CLFS-linked pricing clauses, so they’re prepared to negotiate the fee schedule during contract renewal. It’s a small step, but it can save your lab from an unexpected reimbursement surprise well after the Medicare headlines have faded.
If Congress fails to enact the RESULTS Act, the current PAMA framework snaps back into place once the temporary 2026 delay expires. That means the original schedule of payment reductions, up to 15% annually, could resume for 2027 and beyond, hitting the same roughly 800 tests that have been targeted for cuts for years now. Labs would also return to the old three-year reporting cycle, without the narrower “non-widely available test” reporting scope the RESULTS Act proposes.
That’s exactly why industry groups representing everyone from pathologists to hospital labs to independent diagnostic companies have been pushing so hard for passage. The College of American Pathologists advocated for it, stating that the current PAMA structure, left unchanged, would undermine the operational infrastructure of clinical laboratories across the country.
Here’s the truth: legislative uncertainty isn’t going away anytime soon, even with a favorable outcome for the RESULTS Act. Rate freezes, phased reporting, new claims databases: all of it adds layers of complexity to an already dense billing process. That’s precisely where a dedicated lab billing partner, such as TransLabs, earns its keep.
When you partner with a lab billing service provider, they track CLFS updates, PAMA reporting windows, and CMS program memoranda daily, not occasionally. They build coding accuracy checks, denial prevention workflows, and revenue forecasting models specifically around what’s happening in clinical lab reimbursement right now, not what was true two years ago. Whether the RESULTS Act passes this year or gets pushed into 2027, having a billing partner who’s already anticipating both outcomes means your lab is fully prepared when the final rules come into effect.
The RESULTS Act 2025 isn’t law yet, but it’s already changing how smart labs approach billing, forecasting, and compliance in 2026. Whether it passes this year or slips into next year’s negotiations, one thing’s for certain: the labs that prepare now, rather than waiting for a final vote, will be the ones best positioned to protect their revenue no matter which way Congress goes.
Don’t wait for the news. Get your CLFS codes audited, your reporting data organized, and your billing partner locked in, so your lab is ready no matter what 2027 brings.