CPT code 0403U: Prostate mRNA test, 18 genes, first-catch urine2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An 18-gene mRNA profile of first-catch urine estimates the likelihood of clinically significant prostate cancer during diagnostic evaluation.
Medicare pays $760.00 for 0403U 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
$760.00
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2024
- 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 0403U covers
This molecular profile measures expression across 18 genes in first-catch urine and uses an algorithm to report a percentage likelihood of detecting clinically significant prostate cancer. It may be ordered during evaluation of a patient with concern for prostate cancer, including when a clinician is assessing whether to proceed with biopsy. The result supports clinical decision-making; it is not a tissue diagnosis. A laboratory performs and reports the assay for the ordering clinician.
Report 0403U for this urine-based gene-expression profile. Medicare pays it through the Clinical Laboratory Fee Schedule, with one national amount applying across localities and no office-versus-facility difference. The 2026 national CLFS amount is $760.00, unchanged from 2024. Medicare pays the code through the CLFS; there is no physician fee schedule row for a separate physician interpretation 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 0403U
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 0403U. 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 0403U: Medicare pays the test only from the CLFS.
0403U on the lab fee schedule since 2023
0403U · CLFS 2026 Q4 (current)
$760.00
Unchanged since Jan 1, 2024
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $760.00
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0403U compared with similar tests
- 84153Total PSA$18.39
- 84153 measures total PSA in serum or plasma. Choose 0403U when the service performed is the 18-gene mRNA profile on first-catch urine.
- 84154Free PSAUnbound PSA fraction$18.39
- 84154 measures free PSA, generally in relation to total PSA. It is not the urine gene-expression assay reported with 0403U.
- 81539Prostate risk scoreFour-protein probability score$760.00
- 81539 reports a prostate cancer risk result from a serum biomarker algorithm. 0403U uses first-catch urine and an 18-gene mRNA profile.
0403U billing questions
What distinguishes 0403U from a PSA test?
0403U is an 18-gene mRNA profile performed on first-catch urine and reports a percentage likelihood of clinically significant prostate cancer. A PSA test measures a serum prostate marker rather than gene expression in urine.
When might a clinician order this profile?
It may be used during prostate cancer evaluation when the clinician is estimating the likelihood of clinically significant disease and considering whether biopsy is appropriate.
What specimen does this assay use?
The assay uses first-catch urine for its 18-gene mRNA profile.
Is there a separately payable physician interpretation?
Medicare pays 0403U through the CLFS, and the code has no physician fee schedule row for a separate interpretation component.
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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