CPT code 0019M: Cardiovascular biomarkers, four-year coronary-event likelihood2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This plasma protein biomarker analysis uses an algorithm to report a four-year coronary-event likelihood for patients in high-risk populations.
Medicare pays $712.40 for 0019M under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$712.40
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2025
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 7 sections
What 0019M covers
The laboratory analyzes plasma protein biomarkers using an aptamer-based microarray and an algorithm. It reports a likelihood of a coronary event over four years for cardiovascular risk assessment in high-risk populations. Clinicians managing cardiovascular risk may order the test, and a laboratory performs the analysis and reports the result.
Report 0019M for the plasma biomarker analysis and its algorithmic likelihood result. Medicare pays the code through the Clinical Laboratory Fee Schedule (CLFS), with one national amount applying in every state and locality and no geographic or office/facility adjustment. The 2026 national CLFS amount is $712.40, unchanged from 2025. The code is paid only from the CLFS, with no separate physician interpretation payment under the physician fee schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 0019M
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 0019M. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Not on the physician fee schedule
The physician fee schedule doesn’t list 0019M: Medicare pays the test only from the CLFS.
0019M on the lab fee schedule since 2023
0019M · CLFS 2026 Q4 (current)
$712.40
Unchanged since Jan 1, 2025
Every change on file
- Jan 1, 2025 · CLFS 2025 Q1MAC-priced → $712.40
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0019M compared with similar tests
- 80061Lipid panelCholesterol and triglycerides$13.39
- Code 80061 represents a lipid panel measuring cholesterol and triglycerides. Code 0019M represents a plasma protein biomarker analysis with an algorithmic four-year coronary-event likelihood.
- 86141High-sensitivity CRPHigh-sensitivity measurement$12.95
- Code 86141 represents high-sensitivity C-reactive protein testing. Code 0019M represents a plasma protein biomarker analysis reported as a coronary-event likelihood.
- 82172ApolipoproteinEach apolipoprotein measured$21.09
- Code 82172 represents apolipoprotein measurement. Code 0019M represents a plasma protein biomarker analysis with an algorithmic likelihood result.
0019M billing questions
How does 0019M differ from a lipid panel?
0019M analyzes plasma protein biomarkers and reports an algorithmic four-year coronary-event likelihood. A lipid panel measures cholesterol and triglycerides.
What specimen is used for 0019M?
The test analyzes plasma. The reported result is a likelihood of a coronary event over four years.
What result does 0019M report?
It reports an algorithmic likelihood of a coronary event over four years for patients in high-risk populations.
Is a physician interpretation separately payable?
No. Medicare pays 0019M through the CLFS, and there is no separate physician interpretation payment under the physician fee schedule.
How does Medicare pay 0019M?
Medicare pays one national CLFS amount across states and localities, without a geographic or office/facility adjustment.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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