CPT code 0172U: Tumor gene assay, BRCA1/2 and genomic instability2026 Medicare lab fee · Clinical Laboratory Fee Schedule
0172U reports a solid-tumor DNA assay examining somatic BRCA1/BRCA2 changes, homologous-recombination-deficiency pathways, and tumor genomic instability.
Medicare pays $3,030.00 for 0172U 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
$3,030.00
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- 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 0172U covers
0172U identifies a proprietary molecular assay of DNA from formalin-fixed, paraffin-embedded solid-tumor tissue. The analysis examines somatic BRCA1 and BRCA2 mutations and homologous-recombination-deficiency pathways, then uses an algorithm to quantify tumor genomic instability as a score. The assay combines gene and pathway analysis with a genomic-instability measure, distinguishing it from a BRCA1/BRCA2-only description. It is an oncology solid-tumor test reported from analysis of the submitted tissue.
Report 0172U for this assay. Medicare pays it through the Clinical Laboratory Fee Schedule (CLFS) at one national amount, applicable in every state and locality without geographic or office/facility adjustment. The 2026 national CLFS amount is $3,030 and has remained unchanged since 2020. The code is paid through the CLFS only.
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 0172U
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 0172U. 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 0172U: Medicare pays the test only from the CLFS.
0172U on the lab fee schedule since 2020
0172U · CLFS 2026 Q4 (current)
$3,030.00
Unchanged since Oct 1, 2020
Every change on file
- Oct 1, 2020 · CLFS 2020 Q4MAC-priced → $3,030.00
26 quarterly CLFS releases on file, first CLFS 2020 Q3. A code missing from a quarter wasn’t on that release.
0172U compared with similar tests
- 0171UGenomic panel23-gene blood cancer panel$1,519.06
- 0171U describes a targeted DNA sequencing panel covering 23 genes. 0172U analyzes BRCA1, BRCA2, homologous-recombination-deficiency pathways, and tumor genomic instability.
- 0174UTumor protein assay30 targets by mass spectrometry$1,305.37
- 0174U is a solid-tumor assay focused on 30 protein targets. 0172U analyzes tumor DNA for BRCA1/BRCA2 and genomic-instability features.
- 0177UPIK3CA testPlasma, 11 variants$274.83
- 0177U focuses on PIK3CA DNA analysis in breast cancer. 0172U evaluates BRCA1/BRCA2 and homologous-recombination-deficiency features in solid-tumor tissue.
0172U billing questions
When should 0172U be selected instead of a broader tumor DNA panel?
Use 0172U when the ordered assay analyzes BRCA1, BRCA2, homologous-recombination-deficiency pathways, and tumor genomic instability. 0171U describes a targeted DNA sequencing panel with a different gene-panel scope.
Are the BRCA1, BRCA2, pathway, and score findings billed separately?
0172U identifies an assay that includes BRCA1 and BRCA2 analysis, homologous-recombination-deficiency pathway analysis, and a genomic-instability score.
What specimen is analyzed?
The assay analyzes DNA from formalin-fixed, paraffin-embedded solid-tumor tissue.
How does Medicare pay 0172U?
Medicare pays it under the CLFS at one national amount across localities, without an office-versus-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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