Final 2026 Clinical Lab Fee Schedule Indicates a 47% Increase in Payment Determination for the Category I CPT Code for OGM use in Hematologic Malignancies

Core Insights - Bionano Laboratories announced a significant increase of 47% in the clinical lab fee schedule for the CPT code 81195, raising it from $1263.53 to $1853.22, effective January 1, 2026, which pertains to optical genome mapping (OGM) for hematologic malignancies [1][2][4] Summary by Sections Payment Determination - The Centers for Medicare & Medicaid Services (CMS) previously set the payment for CPT code 81195 at $1263.53, effective January 1, 2025, based on a crosswalk to an existing code. A request for reconsideration led to a unanimous vote by the clinical diagnostic laboratory test committee to re-price the code to $1853.22, effective January 1, 2026 [2] Importance of CPT Codes - CPT codes for OGM are essential for reimbursement from third-party payers for Bionano Laboratories' laboratory developed tests (LDTs). Currently, there are two codes: 81195 for hematologic malignancy analysis and 81354 for constitutional genetic disease [3] Impact on OGM Services - The increase in reimbursement for CPT code 81195 is expected to facilitate the offering of OGM-based LDTs for hematologic malignancies, as it provides a more favorable reimbursement environment. The new payment level is deemed appropriate for the additional data collection and reporting required for OGM in blood cancers [4] Company Overview - Bionano Laboratories, a subsidiary of Bionano Genomics, specializes in optical genome mapping (OGM) testing and offers a range of diagnostic services. The company aims to transform genome analysis through advanced technologies and provides OGM solutions for various research applications [5][6]