CPT code 0214U: Rare disease exome testing, proband sequencing2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Whole-exome and mitochondrial DNA testing evaluates protein-coding genes in a proband during assessment of suspected rare constitutional or inherited disease.
Medicare pays $5,224.60 for 0214U 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
$5,224.60
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 0214U covers
0214U identifies rare-disease testing of protein-coding genes in the proband, the first affected person evaluated in a family. The analysis uses whole-exome and mitochondrial DNA sequencing to 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 when performing the analysis. A clinician may order it while evaluating a suspected constitutional or inherited disorder.
Report 0214U for the proband analysis. The related code 0215U is for each comparator analyzed with the proband under this exome and mitochondrial DNA testing pathway. Medicare pays 0214U under the CLFS at one national amount across localities, with no office-versus-facility difference. The 2026 national CLFS amount is $5,224.60, unchanged from 2022 through 2026. The code is paid through the CLFS only, with no physician fee schedule payment component.
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 0214U
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 0214U. 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 0214U: Medicare pays the test only from the CLFS.
0214U on the lab fee schedule since 2020
0214U · CLFS 2026 Q4 (current)
$5,224.60
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $5,224.60
25 quarterly CLFS releases on file, first CLFS 2020 Q4. A code missing from a quarter wasn’t on that release.
0214U compared with similar tests
- 0212UGenome analysisRare disease, proband$5,475.20
- 0212U identifies a related rare-disease genomic analysis for the proband. Choose 0214U when the analysis performed is whole-exome and mitochondrial DNA testing.
- 0213URare disease genome testEach comparator genome$2,709.95
- 0213U identifies each comparator for the related genomic DNA analysis. 0215U identifies each comparator for the exome and mitochondrial DNA analysis associated with 0214U.
- 0215UComparator exomeEach relative tested$2,574.65
- 0215U identifies each comparator analyzed with the proband; 0214U identifies the proband's exome and mitochondrial DNA analysis.
0214U billing questions
When should 0214U be chosen over 0212U?
0214U identifies proband testing using whole-exome and mitochondrial DNA analysis. Choose between the codes based on the analysis performed.
What is reported for each comparator?
0215U is the related code for each comparator analyzed with the proband under the exome and mitochondrial DNA testing pathway.
Does 0214U identify the proband or a comparator?
0214U identifies the proband analysis; 0215U identifies each comparator analysis.
Does Medicare pay 0214U under the physician fee schedule?
No. Medicare pays 0214U through the CLFS at one national amount across localities, without an office-versus-facility difference.
What specimen may be used?
Blood or saliva may be used for the analysis.
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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