CPT code 0212U: Genome analysis, rare disease, proband2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Whole-genome and mitochondrial DNA analysis of the first affected family member evaluates genetic variants when investigating a suspected rare inherited disorder.
Medicare pays $5,475.20 for 0212U 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
$5,475.20
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2022
- 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 8 sections
What 0212U covers
This proprietary laboratory analysis examines whole-genome and mitochondrial DNA from a proband—the first affected family member tested—for a rare inherited disorder. The analysis identifies and categorizes genetic variants, including sequence changes, deletions, duplications, short tandem repeat expansions, and variants in difficult-to-map regions. Blood or saliva may be used. This code is distinct from testing additional family members.
Report 0212U for the proband’s whole-genome analysis, rather than for each variant identified. The related code 0213U applies to each additional family member when the corresponding whole-genome analysis is performed. Medicare pays 0212U through the Clinical Laboratory Fee Schedule (CLFS), with one national amount and no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $5,475.20, unchanged from 2022 through 2026. The code is paid only through the CLFS; it has no physician fee schedule payment row.
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 0212U
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 0212U. 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 0212U: Medicare pays the test only from the CLFS.
0212U on the lab fee schedule since 2020
0212U · CLFS 2026 Q4 (current)
$5,475.20
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $5,475.20
25 quarterly CLFS releases on file, first CLFS 2020 Q4. A code missing from a quarter wasn’t on that release.
0212U compared with similar tests
- 0213URare disease genome testEach comparator genome$2,709.95
- 0212U is for the first affected family member tested; 0213U is for each additional family member receiving the corresponding whole-genome analysis.
- 0214URare disease exome testingProband sequencing$5,224.60
- Both apply to the proband, but 0212U describes whole-genome and mitochondrial DNA analysis, while 0214U describes exome analysis.
- 0215UComparator exomeEach relative tested$2,574.65
- 0212U describes whole-genome analysis of the proband. Code 0215U describes exome analysis for each additional family member.
0212U billing questions
Who is the proband for 0212U?
The proband is the first affected person in the family whose complete DNA is analyzed. Use the related code for additional family members tested.
Which code applies to an additional family member?
For whole-genome analysis of each additional family member, see 0213U. Code 0212U is for the proband.
How does 0212U differ from 0214U?
0212U describes whole-genome and mitochondrial DNA analysis of the proband. Code 0214U describes exome analysis of the proband.
Is 0212U reported per variant or per specimen?
The code describes the proband’s comprehensive genetic analysis, not a separate report for each variant. Blood or saliva may be used.
How does Medicare pay 0212U?
Medicare pays the code through the CLFS at one national amount, without a locality or office-versus-facility adjustment. It has no physician fee schedule payment row.
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
Fee sheets · Coming soon
Put 0212U and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist