PAMA 2026 cycle: every date, figure, and source
A lookup page: the operative dates and figures of the private payor rate-based CLFS as they stand for the 2026 cycle, one row per fact, one primary source per row. Every source was read on 2026-08-25; regulation text is the eCFR’s as of August 20, 2026. Where a currently codified text is superseded by statute, the row says so, because this cycle’s single biggest documentation hazard is quoting a text one law behind.
The current cycle
| fact | value | source |
|---|---|---|
| Data collection period | January 1, 2025 through June 30, 2025 | Section 6226(b), Public Law 119-75 (rebasing section 1834A(a)(4)(B) on 2025); CMS FAQ A1.1 |
| Data reporting period | May 1, 2026 through July 31, 2026, now closed | Section 6226(c), inserting “May 1, 2026, and ending July 31, 2026”; CMS page: “The 2026 data reporting period ended on July 31, 2026.” |
| Enactment setting those dates | February 3, 2026 | Public Law 119-75, 140 Stat. 684 |
| Rates set by this cycle’s data | CY 2027 through CY 2029 | CMS FAQ A1.2 |
| Next reporting cycles (non-ADLT CDLTs) | “will resume (that is 2029, 2032, etc.)” | CMS FAQ, introduction |
| Collection window feeding the 2029 cycle | not stated in any source read for this page | absence noted as of 2026-08-25 |
| Reporting cadence, non-ADLT CDLTs | every 3 years | 42 CFR 414.504(a)(1) |
| Reporting cadence, ADLTs (not new) | every year | 42 CFR 414.504(a)(2) |
This cycle’s window moved twice in its final fourteen months, which is why documents dated months apart contradict each other while all were right when written:
| window as stated | stated by | status |
|---|---|---|
| January 1, 2026 through March 31, 2026, on 2019 collection data | 42 CFR 414.502, text as amended through 89 FR 98559 (December 9, 2024), still the codified text on August 20, 2026 | superseded by statute, never re-amended |
| February 1, 2026 through April 30, 2026 | the statutory text in force before February 3, 2026: Section 6226(c) strikes the words “February 1, 2026, and ending April 30, 2026” | superseded by Section 6226 |
| May 1, 2026 through July 31, 2026 | Section 6226(c), Public Law 119-75; CMS FAQ A1.1 | the window that actually ran |
CMS’s FAQ lists the delay statutes in order; the one immediately before Section 6226 is section 6209 of Public Law 119-37, enacted November 12, 2025.
The two status tests
Applicable laboratory status is self-determined against 42 CFR 414.502. The definition’s load-bearing sentence, verbatim: the entity “In a data collection period, receives more than 50 percent of its Medicare revenues” from the CLFS, the Physician Fee Schedule, or their combination.
| test | bar | source |
|---|---|---|
| Majority of Medicare revenues | strictly more than 50 percent from CLFS plus PFS, during the collection period | 42 CFR 414.502, applicable laboratory, paragraph (3) |
| Low expenditure threshold | at least $12,500 of Medicare CLFS revenues, during the 6 month collection period | 42 CFR 414.502, applicable laboratory, paragraph (4) |
| ADLT carve-out | the $12,500 bar “Does not apply with respect to the ADLTs” a single laboratory offers and furnishes, and “Applies with respect to all the other CDLTs it furnishes” | 42 CFR 414.502, applicable laboratory, paragraph (4) |
| What counts as Medicare revenues | “fee-for-service payments under Medicare Parts A and B, prescription drug payments under Medicare Part D, and any associated Medicare beneficiary deductible or coinsurance” | 42 CFR 414.502, applicable laboratory, paragraph (3) |
| Medicare Advantage payments | excluded from Medicare revenues since January 1, 2019 | CMS FAQ A3.4 |
| Entity tested | the NPI billing Medicare Part B (or the CMS-1450 type of bill 14x stream, for a hospital outreach laboratory) | 42 CFR 414.502, applicable laboratory, paragraphs (2) and (2)(i) |
Payment mechanics and the phase-in caps
Rates equal the weighted median of reported private payor rates (42 CFR 414.507(a) and (b)), with no geographic or other adjustment (414.507(c)) and no administrative or judicial review (414.507(e)). The caps below limit only how far an existing test’s rate can fall year over year; they cap nothing upward, and they do not cover new CDLTs or new ADLTs (414.507(d)).
| years | maximum reduction per year | source, and standing |
|---|---|---|
| 2018, 2019, 2020 | 10 percent | 42 CFR 414.507(d)(1) through (d)(3) |
| 2021 through 2025 | 0.0 percent | 42 CFR 414.507(d)(4) through (d)(8) |
| 2026 | 0.0 percent by statute; the codified 414.507(d)(9) still prints 15 percent and is superseded | Section 6226(a), Public Law 119-75; CMS FAQ: “There is a 0.0 percent reduction for CY 2021 through 2026”; CMS page: “There's no phase-in reduction in 2026.” |
| 2027, 2028, 2029 | 15 percent | Section 6226(a), inserting “each of 2027 through 2029” into section 1834A(b)(3); CMS FAQ |
The regulation’s lag is not an error to report; Section 6226(d) states the Secretary “may implement the amendments made by this section by program instruction or otherwise”, so no rulemaking had to precede the new schedule.
Reporting mechanics
| fact | value | source |
|---|---|---|
| Who files | the TIN-level reporting entity, for its component applicable laboratories | 42 CFR 414.502, reporting entity; 42 CFR 414.504(a) |
| Who signs | “the President, CEO, or CFO of a reporting entity”, or a delegate reporting directly to such an officer | 42 CFR 414.504(d) |
| What is filed | each private payor rate with final payment in the collection period, the volume at each rate, the specific HCPCS code | 42 CFR 414.502, applicable information |
| Capitated payments | not applicable information | 42 CFR 414.502, applicable information, paragraph (2) |
| Files per TIN | one: “the data collection system will accept only one submission per TIN” | CMS FAQ Q4.24 |
| Voluntary reporting by non-applicable entities | prohibited: applicable information “may not be reported for an entity that does not meet the definition of an applicable laboratory” | 42 CFR 414.504(g) |
| Confidentiality of reported data | CMS and contractors will not disclose it in a manner identifying a payor or laboratory, with named oversight exceptions | 42 CFR 414.504(f) |
Penalty figures
| figure | amount | source |
|---|---|---|
| Statutory civil monetary penalty | up to $10,000 per day, per failure to report or per misrepresentation or omission | 42 CFR 414.504(e); CMS FAQ Q6.1 |
| 2024 maximum adjusted penalty | $12,958 per day | 45 CFR 102.3, table 1, row cross-referencing 42 CFR 414.504(e) |
| 2025 maximum adjusted penalty | $13,295 per day | 45 CFR 102.3, same row; “The civil monetary penalty amounts are adjusted annually.” |
Reading order when texts disagree
Statute as amended first (Public Law 119-75 for this cycle), CMS’s dated operational pages second, the codified regulation last: 42 CFR 414.502 and 414.507 both still carry text amended only through 89 FR 98559 (December 9, 2024) and predate the February 2026 statute. This ordering is this page’s one piece of judgment; every other row is transcription. What none of these sources holds, because it is not public, is any individual laboratory’s revenue composition: the boundary between what public sources prove and what only a lab’s own records can establish is drawn at pamawatch.com/method.
Sources for the whole page: eCFR texts of 42 CFR 414.502, 414.504, 414.507 and 45 CFR 102.3 as of August 20, 2026, read 2026-08-25; Public Law 119-75, Section 6226 (140 Stat. 684), read 2026-08-25 on govinfo; CMS CLFS and PAMA Reporting and Resources page, last modified August 3, 2026, read 2026-08-25; CMS Private Payor Rate-Based CLFS FAQs, updated July 14, 2026, read 2026-08-25. Quotes verbatim, with the site’s standing rule of rendering any source dash as a colon or splitting the quote around it.
Published by Neige AI, Inc. See the method and sources.
This page is independent research, not legal or financial advice. It quotes 42 CFR part 414, 45 CFR 102.3 and Public Law 119-75 with pinpoint citations. Verify anything load-bearing against the primary text itself before acting on it.
See where your lab’s own billing sits before the next reporting cycle
One NPI or lab name, about a minute, no account required.
Check my lab now