Medicare Clinical Laboratory Fee Schedule Update (Effective 1/1/2026)

Billing Alerts
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CMS has announced updates to the Medicare Clinical Laboratory Fee Schedule, including:

  • New Code: CPT code 87812 QW for combination tests that are read visually.

  • Retired Code: CPT code 87428 QW for combination tests that are read visually.

These changes are effective starting January 1, 2026.

Why this change?

CMS is updating the fee schedule to reflect current testing technologies and practices. The new codes aim to improve accuracy and reimbursement processes for combination tests.

What you need to do:

  • Review: Assess your laboratory’s testing protocols to identify the affected tests.

  • Update: Ensure EMR and billing systems are updated with the new CPT code 87812 QW.

  • Train: Educate laboratory and billing staff including external partners on the changes to prevent claim denials.

  • Monitor: Keep an eye on claims submissions starting January 1, 2026, for any issues related to the new codes.

For more details, refer to the CMS MLN Connects Newsletter – September 25, 2025