CPT code 0215U: Comparator exome, each relative tested2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Whole-exome and mitochondrial DNA sequencing of an affected person’s relative supports rare-disease variant comparison and is reported once per comparator exome.
Medicare pays $2,574.65 for 0215U 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
$2,574.65
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 0215U covers
0215U represents sequencing of a relative’s protein-coding genes for rare-disease genetic evaluation. The analysis uses whole-exome and mitochondrial DNA sequencing to identify and categorize genetic variants, including small sequence changes, deletions, duplications, short tandem repeat expansions, and variants in regions that are difficult to map uniquely. Blood or saliva is used. The relative’s results provide comparator information alongside evaluation of the affected person; each comparator exome is a separately counted analysis.
Report one unit for each comparator exome analyzed; report the affected person’s proband exome separately with 0214U. Medicare pays 0215U through the CLFS at one national amount across states and localities, without an office-versus-facility difference. The 2026 national CLFS amount is $2,574.65, unchanged from 2022 through 2026.
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 0215U
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 0215U. 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 0215U: Medicare pays the test only from the CLFS.
0215U on the lab fee schedule since 2020
0215U · CLFS 2026 Q4 (current)
$2,574.65
Unchanged since Jan 1, 2022
Every change on file
- Jan 1, 2022 · CLFS 2022 Q1MAC-priced → $2,574.65
25 quarterly CLFS releases on file, first CLFS 2020 Q4. A code missing from a quarter wasn’t on that release.
0215U compared with similar tests
- 0214URare disease exome testingProband sequencing$5,224.60
- Use 0214U for the affected person’s proband exome; use 0215U for a relative’s comparator exome.
- 0213URare disease genome testEach comparator genome$2,709.95
- 0213U is the comparator genetic DNA analysis code. 0215U is the comparator exome analysis that includes mitochondrial DNA sequencing.
- 0212UGenome analysisRare disease, proband$5,475.20
- 0212U describes rare-disease genetic DNA analysis of the proband. 0215U describes exome analysis of a relative for comparison.
0215U billing questions
When should 0215U be reported instead of 0214U?
0215U is for a relative’s comparator exome. 0214U is for the affected person’s proband exome.
How many units are reported?
Report one unit for each comparator exome analyzed.
Which specimens are used for 0215U?
Blood or saliva is used.
How does 0215U differ from 0213U?
0215U is the comparator exome analysis that includes mitochondrial DNA sequencing. 0213U is the related comparator genetic DNA analysis code.
Does Medicare payment for 0215U vary by locality or setting?
No. The CLFS pays one national amount across states and localities, without an office-versus-facility difference.
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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