| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | AF | AG | AH | AI | AJ | AK | AL | AM | AN | AO | AP | AQ | AR | AS | AT | AU | AV | AW | AX | AY | AZ | BA | BB | BC | BD | BE | BF | BG | BH | ||
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1 | Clinical Diagnostic Laboratory Fee Schedule- 2026 Gapfill Preliminary Determinations to be implemented in CY 2027 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2 | 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). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
3 | 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. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
4 | Comments may be submitted to clfs_inquiries@cms.hhs.gov by 07/13/2026 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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6 | 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 | |
7 | 0420U | Oncology (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 | |
8 | 0526U | Nephrology (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 | |
9 | 0529U | Hematology (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 | |
10 | 0531U | Infectious 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 | |
11 | 0534U | Oncology (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 | |
12 | 0541U | Cardiovascular 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 | |
13 | 0542U | Nephrology (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 | |
14 | 0552U | Testing 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 | |
15 | 0569U | Next-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 | |
16 | 0572U | High-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 | |
17 | 0573U | Testing 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 | |
18 | 0574U | Culture 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 | |
19 | 87182 | Susceptibility 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 | |
20 | 81524 | Oncology (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 | |
21 | 0590U | Infectious 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 | |
22 | 0594U | Infectious 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 | |
23 | 0596U | Neurology (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 | |
24 | 0597U | Oncology (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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