CPT code 0405U: Pancreatic cancer assay, plasma methylation markers2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This plasma sequencing assay examines 59 methylation haplotype block markers and reports a qualitative pancreatic cancer signal for clinical evaluation.
Medicare pays $1,770.48 for 0405U 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
$1,770.48
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 7 sections
What 0405U covers
This proprietary laboratory assay uses next-generation sequencing to examine 59 methylation haplotype block markers in plasma and reports whether a pancreatic cancer signal is detected. The finding is a qualitative molecular signal result, distinct from a single-antigen measurement such as CA 19-9 and from solid-tumor DNA/RNA profiling. The performing laboratory reports the result for clinicians evaluating pancreatic cancer. The reported categories are detected and not detected.
Medicare pays 0405U under the Clinical Laboratory Fee Schedule (CLFS), with one national amount applying across states and localities and no office or facility difference. The 2026 national amount is $1,770.48, unchanged from 2024 and 2025. The code is paid only from the CLFS.
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 0405U
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 0405U. 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 0405U: Medicare pays the test only from the CLFS.
0405U on the lab fee schedule since 2023
0405U · CLFS 2026 Q4 (current)
$1,770.48
Unchanged since Jan 1, 2024
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $1,770.48
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0405U compared with similar tests
- 86301CA 19-9Quantitative tumor antigen$20.81
- 0405U is a plasma methylation-marker sequencing assay with a qualitative signal result; 86301 reports a CA 19-9 tumor antigen test.
- 82378CEA testProtein level$18.96
- 0405U assesses a pancreatic cancer signal from plasma methylation markers. Code 82378 reports carcinoembryonic antigen testing.
- 0409UTumor profilingPlasma DNA and RNA$2,919.60
- 0405U evaluates pancreatic cancer through plasma methylation markers. Code 0409U is an oncology assay involving solid-tumor DNA and RNA.
0405U billing questions
What specimen and method identify 0405U?
The assay uses plasma and next-generation sequencing of 59 methylation haplotype block markers.
What result does 0405U report?
It reports a qualitative result: pancreatic cancer signal detected or not detected.
How does 0405U differ from CA 19-9 testing?
0405U sequences plasma methylation markers and reports a cancer signal. Code 86301 reports a CA 19-9 tumor antigen test.
How does Medicare pay 0405U?
Medicare pays the code under the CLFS at one national amount across states and localities, with no office or 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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