The Centers for Medicare & Medicaid Services plans to align its 2027 clinical laboratory fee schedule rates with private sector payer rates, aiming to curb excessive Medicare payments and save taxpayers an estimated $1 billion annually.
• BillionToOne stock is facing resistance. What’s pulling BLLN shares down?
CMS Proposes Payment Alignment To Reduce Medicare Costs
Preliminary data show Medicare currently pays roughly 16% more for laboratory services than private insurers.
To address this discrepancy, the agency will phase in payment reductions capped at 15% annually through 2029, with finalized rates expected in November 2026 before taking effect on Jan. 1, 2027.
Company-Level Exposure Varies Across Diagnostics Sector
While broad molecular and genomic test categories face steep payment cuts, proprietary diagnostic tests remain better insulated, according to financial firm William Blair.
Consequently, aggregate agency statistics fail to accurately reflect specific corporate exposures across the diagnostics industry.
For BillionToOne Inc. (NASDAQ:BLLN), oncology updates offer a significant boost. Preliminary reimbursement rates for its Northstar Response test increased 29% from $1,644 to $2,124.
Analyst Matt Larew views this as particularly encouraging ahead of anticipated Molecular Diagnostic Services (MolDX) program coverage decisions by year-end, especially given the larger late-stage monitoring opportunity where Northstar Response continues gaining traction.
The company’s prenatal segment presents a mixed outlook, as the shared aneuploidy code rate falls 23% — subject to the 15% annual reduction cap — while reimbursement for UNITY Fetal Risk jumps 112%. Management views the net impact as neutral in prenatal and positive in oncology.
Favorable Reimbursement Outlook For CareDx Portfolio
Meanwhile, CareDx Inc. (NASDAQ:CDNA) received favorable updates across its core organ transplant portfolio. Preliminary rates keep AlloMap reimbursement unchanged at $3,240 while raising AlloSure payments about 3% from $2,753.25 to $2,840.
The company’s NavDx test remains unaffected by this fee schedule update due to its Advanced Diagnostic Laboratory Test status, which uses a separate annual reporting process with an $1,800 Medicare rate.
The proposals avoid reimbursement headwinds for key tests and provide modest support for AlloSure.
BLLN, CDNA Price Actions: BillionToOne shares were down 0.79% to $115.15; CareDX stock was down 1.61% at $55.61at the time of publication on Wednesday, according to Benzinga Pro data.
Image via Shutterstock/ Christian Delbert
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