Bionano notes 2026 CLFS indicates 47% increase in payment determination

Bionano Laboratories announced that the clinical lab fee schedule for 2026 posted by Centers for Medicare & Medicaid Services indicates an increase of 47%, from $1263.53 to $1853.22, for the payment for the Category I Current Procedural Terminology code 81195. This code applies to use of OGM in cytogenomic genome-wide analysis to detect structural and copy number variations related to hematologic malignancies, or blood cancers. CMS previously established a payment determination, effective January 1, 2025, for the Category 1 CPT code 81195 at $1263.53 based on a crosswalk to an existing code. A request for reconsideration and crosswalk to a different code with a higher payment rate was made. The clinical diagnostic laboratory test committee that reviews such applications voted unanimously in favor of the proposed crosswalk by a vote of 10-0 with no abstentions. CMS subsequently agreed with the panel and the OGM users who commented as part of the process and re-priced code 81195 to $1853.22, effective January 1, 2026.