CPT code 0213U: Rare disease genome test, each comparator genome2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Whole-genome and mitochondrial DNA analysis of a relative’s sample supports interpretation of genetic findings in a person with a suspected rare disease.
Medicare pays $2,709.95 for 0213U 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
$2,709.95
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 0213U covers
This proprietary laboratory analysis sequences a relative’s whole genome and mitochondrial DNA to help interpret genetic findings in an affected person. The assay can identify and categorize small sequence changes, deletions, duplications, short tandem repeat expansions, and variants in regions that are difficult to map uniquely. Blood or saliva may be used. A molecular laboratory reports the analysis for each comparator genome, such as a parent’s or sibling’s genome, in relation to the affected person’s testing.
Report 0213U for each comparator genome analyzed; it represents the relative’s analysis, not the affected person’s proband analysis. Medicare pays the code under the CLFS at one national amount, with the same payment across localities and no geographic or office/facility adjustment. The 2026 national CLFS amount is $2,709.95, unchanged from 2022 through 2026. The code is paid only from the CLFS; it has no physician fee schedule payment.
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 0213U
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 0213U. 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 0213U: Medicare pays the test only from the CLFS.
0213U on the lab fee schedule since 2020
0213U · CLFS 2026 Q4 (current)
$2,709.95
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $2,709.95
25 quarterly CLFS releases on file, first CLFS 2020 Q4. A code missing from a quarter wasn’t on that release.
0213U compared with similar tests
- 0212UGenome analysisRare disease, proband$5,475.20
- 0212U is for the affected person’s analysis as the proband. Use 0213U for a relative’s comparator genome.
- 0214URare disease exome testingProband sequencing$5,224.60
- 0214U is rare-disease exome analysis for the proband. 0213U is whole-genome and mitochondrial DNA analysis of a relative.
- 0215UComparator exomeEach relative tested$2,574.65
- 0215U analyzes an exome for each comparator genome. 0213U is the corresponding whole-genome and mitochondrial DNA comparator analysis.
0213U billing questions
When should 0213U be reported instead of 0212U?
0213U is for whole-genome and mitochondrial DNA analysis of a relative used as a comparator. 0212U is the corresponding rare-disease genetic analysis for the affected person, or proband.
How many units should be reported?
The code is reported for each comparator genome analyzed. A separate comparator genome, such as a parent’s or sibling’s, is the basis for each reported service.
Which specimens are used?
The analysis may use blood or saliva from the relative whose genome is being compared with the affected person’s.
How does 0213U differ from 0215U?
Both are rare-disease comparator-genome analyses. 0213U covers whole-genome and mitochondrial DNA analysis, while 0215U is the exome-analysis comparator code.
How does Medicare pay 0213U?
Medicare pays 0213U under the CLFS using one national amount across localities, without a geographic or office/facility adjustment. The code has no physician fee schedule payment.
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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