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Clinical Diagnostic Laboratory Fee Schedule- 2026 Gapfill Preliminary Determinations to be implemented in CY 2027
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CPT codes, descriptions and other data only are copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
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As outlined in Sec 1834A(c)(4); Explanation of payment rates.--In the case of a clinical diagnostic laboratory test for which payment is made under this subsection, the Secretary shall make available to the public an explanation of the payment rate for the test.
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Comments may be submitted to clfs_inquiries@cms.hhs.gov by 07/13/2026
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HCPCS Descriptor Median CA1 CA2 HI NV AK ID OR WA AZ MT ND SD UT WY CO NM OK TX IA KS KS MO2 MO1 NE IL MN WI AR LA MS IN MI FL PR AL GA TN SC VA WV NC DE DC MD NJ PA CT NY2 NY1 NY3 ME MA NH RI VT KY OH
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0420UOncology (urothelial), mRNA expression profiling by real-time quantitative PCR of MDK, HOXA13, CDC2, IGFBP5, and CXCR2 in combination with droplet digital PCR ddPCR) analysis of 6 single-nucleotide polymorphisms (SNPs) genes TERT and FGFR3, urine, algorithm reported as a risk score for urothelial carcinoma $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32$1,328.32$1,328.32$1,328.32$1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32$1,328.32$1,328.32$1,328.32 $1,328.32 $1,328.32$1,328.32$1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32$1,328.32$1,328.32$1,328.32$1,328.32$1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32 $1,328.32
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0526UNephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time$162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $239.54$239.54$239.54$239.54$162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $239.54$239.54$239.54$162.65 $162.65 $239.54$239.54$162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $239.54$239.54$239.54$239.54$239.54$162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65 $162.65
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0529UHematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE$268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $139.06$139.06$139.06$139.06$268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $139.06$139.06$139.06$268.76 $268.76 $139.06$139.06$268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $139.06$139.06$139.06$139.06$139.06$268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76 $268.76
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0531UInfectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), next-generation sequencing, plasma$2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,180.00$2,180.00$2,180.00$2,180.00$2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.20 $2,126.20 $2,126.20 $2,180.00$2,180.00$2,180.00$2,126.00 $2,126.00 $2,180.00$2,180.00$2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,126.00 $2,180.00$2,180.00$2,180.00$2,180.00$2,180.00$2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.20 $2,126.00 $2,126.00
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0534UOncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by RT-PCR of 32 variants, using buccal swab, algorithm reported as a risk score$464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $779.06$779.06$779.06$779.06$464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $79.00 $79.00 $79.00 $779.06$779.06$779.06$464.88 $464.88 $779.06$779.06$464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $464.88 $779.06$779.06$779.06$779.06$779.06$79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $464.88 $464.88
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0541UCardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, and C4), serum, algorithm reported as prediction of coronary artery disease (pCAD) score$150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $120.45
$120.45
$120.45
$120.45
$150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $120.45
$120.45
$120.45
$150.15 $150.15 $120.45
$120.45
$150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $120.45
$120.45
$120.45
$120.45
$120.45
$150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15 $150.15
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0542UNephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of BK virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm reported as a probability score for allograft injury status$218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $306.00$306.00$306.00$306.00$218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $306.00$306.00$306.00$218.32 $218.32 $306.00$306.00$218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $306.00$306.00$306.00$306.00$306.00$218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32 $218.32
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0552UTesting for genetic disorders from outer layer of embryo cells, reported as low-risk or high-risk for familial genetic disorder in preimplantation genetic assessment$1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,324.75$1,324.75$1,324.75$1,324.75$1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $324.18 $324.18 $324.18 $1,324.75$1,324.75$1,324.75$1,160.00 $1,160.00 $1,324.75$1,324.75$1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,160.00 $1,324.75$1,324.75$1,324.75$1,324.75$1,324.75$324.18 $324.18 $324.18 $324.18 $324.18 $324.18 $324.18 $324.18 $324.18 $1,160.00 $1,160.00
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0569UNext-generation sequencing analysis of tumor methylation markers present in cell-free circulating tumor DNA (ctDNA) in whole blood, algorithm reported as presence or absence of ctDNA in solid tumor cancer$1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25$1,644.25$1,644.25$1,644.25$1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25$1,644.25$1,644.25$1,644.25 $1,644.25 $1,644.25$1,644.25$1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25$1,644.25$1,644.25$1,644.25$1,644.25$1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25 $1,644.25
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0572UHigh-throughput telomere length quantification by FISH testing in whole blood, diagnostic algorithm reported as risk of prostate cancer$21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $212.00$212.00$212.00$212.00$21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $212.00$212.00$212.00$21.42 $21.42 $212.00$212.00$21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $212.00$212.00$212.00$212.00$212.00$21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42
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0573UTesting for 3 biomarkers in pancreatic cyst lesion fluid, algorithm reported as categorical mucinous or non-mucinous in pancreatic cancer$853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $591.76$591.76$591.76$591.76$853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $591.76$591.76$591.76$853.14 $853.14 $591.76$591.76$853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $591.76$591.76$591.76$591.76$591.76$853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14 $853.14
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0574UCulture filtrate protein-10-kDa testing in serum or plasma for tuberculosis$24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.09$24.09$24.09$24.09$24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.09$24.09$24.09$24.11 $24.11 $24.09$24.09$24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.09$24.09$24.09$24.09$24.09$24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11 $24.11
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87182Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative, per isolate$9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $13.41$13.41$13.41$13.41$9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $650.00 $650.00 $650.00 $13.41$13.41$13.41$9.65 $9.65 $13.41$13.41$9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $13.41$13.41$13.41$13.41$13.41$650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $9.65 $9.65
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81524Oncology (central nervous system tumor), DNA methylation analysis of at least 10,000 methylation sites, utilizing DNA extracted from formalin-fixed tumor tissue, algorithm(s) reported as probability of matching a reference tumor family and class, and MGMT (O-6-methylguanine-DNA methyltransferase) promoter methylation status, if performed$1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $2,100.00$2,100.00$2,100.00$2,100.00$1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $2,510.21 $2,510.21 $2,510.21 $2,100.00$2,100.00$2,100.00$1,995.69 $1,995.69 $2,100.00$2,100.00$1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $2,100.00$2,100.00$2,100.00$2,100.00$2,100.00$2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $1,995.69 $1,995.69
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0590UInfectious disease (bacterial and fungal), DNA of 44 organisms (34 bacteria, 10 fungi), urine, next-generation sequencing, reported as positive or negative for each organism$650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $547.16$547.16$547.16$547.16$650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $114.43 $114.43 $114.43 $547.16$547.16$547.16$650.00 $650.00 $547.16$547.16$650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $547.16$547.16$547.16$547.16$547.16$114.43 $114.43 $114.43 $114.43 $114.43 $114.43 $114.43 $114.43 $114.43 $650.00 $650.00
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0594UInfectious disease (sepsis), semiquantitative measurement of pancreatic stone protein concentration, whole blood, reported as risk of sepsis$12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.47$12.47$12.47$12.47$12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $2,510.21 $2,510.21 $2,510.21 $12.47$12.47$12.47$12.05 $12.05 $12.47$12.47$12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.05 $12.47$12.47$12.47$12.47$12.47$2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $12.05 $12.05
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0596UNeurology (Alzheimer disease), plasma, 3 distinct isoform-specific peptides (APOE2, APOE3, and APOE4) by liquid chromatography with tandem mass spectrometry (LC-MS/MS), reported as an APOE prototype$137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $150.36$150.36$150.36$150.36$137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $9.65 $9.65 $9.65 $150.36$150.36$150.36$137.00 $137.00 $150.36$150.36$137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $137.00 $150.36$150.36$150.36$150.36$150.36$9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $9.65 $137.00 $137.00
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0597UOncology (breast), RNA expression profiling of 329 genes by targeted next-generation sequencing and 20 proteins by multiplex immunofluorescence, formalin-fixed paraffin-embedded (FFPE) tissue, algorithmic analyses to determine tumor-recurrence risk score$2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,871.25$2,871.25$2,871.25$2,871.25$2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $1,995.69 $1,995.69 $1,995.69 $2,871.25$2,871.25$2,871.25$2,510.21 $2,510.21 $2,871.25$2,871.25$2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,510.21 $2,871.25$2,871.25$2,871.25$2,871.25$2,871.25$1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $1,995.69 $2,510.21 $2,510.21
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