CMS Transmittal R13855CP: July 2026 Quarterly Update to the Clinical Laboratory Fee Schedule (CLFS) and Clinical…
Clinical Laboratory · Effective 2026-07-06
Specialty intelligence
Clinical laboratory Reimbursement Alerts
50 active CMS and MAC reimbursement alerts affect Clinical laboratory billing teams (Critical-severity changes active) — most recent: CMS Transmittal R13855CP: July 2026 Quarterly Update to the Clinical Laboratory Fee Schedule (CLFS) and Clinical…, effective 2026-07-06. Monitored daily across CMS, all 16 MAC jurisdictions, and the Federal Register.
Daily CMS policy updates, MAC LCD revisions, and coding guidance for Clinical laboratorybilling teams. All alerts sourced directly from CMS — including the Medicare Coverage Database that carries every MAC’s LCDs — and the Federal Register.
Total alerts
50
Average signal
63/100
Sources monitored
9
Latest Clinical laboratory alerts
50Federal Register Final Rule: Clinical Laboratory Improvement Amendments of 1988 (CLIA) Fees; Histocompatibility, Personnel, and Alternative Sanctions for Certificate of Waiver Laboratories
Clinical Laboratory · Effective 2024-01-27
CMS Transmittal R13921NCD: NCD 210.3 Screening for Colorectal Cancer-Non-Invasive Biomarker Tests
Clinical Laboratory · Effective 2027-01-04
+ 47 more Clinical laboratory alerts
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MAC contractor coverage
Clinical laboratory billing is subject to both national CMS policy and regional MAC contractor Local Coverage Determinations (LCDs). Coverage from all seven A/B contractors — Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — reaches us through the CMS Medicare Coverage Database, where they publish their LCDs and Billing & Coding Articles; we track it there for updates affecting Clinical laboratory codes. Coverage criteria vary by contractor jurisdiction.
NoridianCGS AdministratorsFirst CoastNational Government ServicesNovitas SolutionsPalmetto GBAWPS
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Weekly digest of CMS and MAC policy changes for Clinical laboratory billing teams.
Frequently asked questions
What MAC contractors issue LCDs for Clinical laboratory billing?
Clinical laboratory billing is subject to regional Local Coverage Determinations (LCDs) from the 7 A/B Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Between them they administer the 12 A/B MAC jurisdictions; a further 4 DME MAC jurisdictions are administered by Noridian and CGS. Coverage criteria and medical necessity requirements vary by jurisdiction. CLV Intelligence monitors all 16 MAC jurisdictions daily for LCD updates affecting Clinical laboratory codes.
How often does CMS update Clinical laboratory reimbursement policy?
CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting Clinical laboratory reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.
What is a Local Coverage Determination (LCD) and how does it affect Clinical laboratory billing?
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For Clinical laboratory billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in Clinical laboratory practices.
Codes we track for Clinical laboratory
The CPT/HCPCS and ICD-10 codes most often affected by Clinical laboratory policy changes we monitor. Each links to its reimbursement-alert history.
Reimbursement guides & resources
Plain-language guides to the policy cycles that drive Clinical laboratory reimbursement — the fee schedule, ICD-10, HCPCS, and Local Coverage Determinations.
2027 Fee Schedule Guide
How the CY2027 Medicare Physician Fee Schedule works and what to track.
ICD-10 Change Center
The FY2027 ICD-10-CM update cycle and the October 1 effective date.
HCPCS Quarterly Update
How HCPCS Level II changes every quarter — Jan, Apr, Jul, Oct.
Tracking LCD Changes
How LCDs change across every MAC jurisdiction and how to track them.
2027 Prep Checklist
A free, printable checklist for the CY2027 fee schedule cycle.
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