The Centers for Medicare & Medicaid Services recently shared updates impacting laboratories and clinicians participating in the Quality Payment Program (QPP).
Clinical Diagnostic Laboratory Reporting
Independent laboratories, physician office labs, and hospital outreach labs that qualify as applicable laboratories under the Clinical Laboratory Fee Schedule (CLFS) must report private payor data between May 1 and July 31, 2026. The reporting period will include data collected from January 1 through June 30, 2025, including applicable HCPCS codes, associated private payor rates, and volume data. Laboratories that meet the reporting criteria should review CMS guidance to prepare for the submission window.
QPP Payment Adjustment Corrections
CMS also identified inaccurate payments affecting some physicians and practitioners under the QPP due to an issue with the 2026 Medicare Physician Fee Schedule conversion factors. The correct updates include a +0.75% conversion factor increase for qualifying Alternative Payment Model (APM) participants and +0.25% for nonqualifying APM participants.
Medicare Administrative Contractors are automatically adjusting affected claims processed between January 1 and February 26, 2026, with most corrections expected to be completed by early May. Providers do not need to take action to receive these adjustments.
Resource: Clinical Diagnostic Laboratories: Get Ready to Report Starting May 1
Quality Payment Program: Claim Adjustments to Correct Conversion Factor