CPT code 0406U: Lung assay, five-marker flow cytometry2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A five-marker flow cytometry assay of sputum applies an algorithm to report a likelihood of lung cancer during evaluation of suspected disease.
Medicare pays $760.00 for 0406U 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 0406U covers
This proprietary laboratory analysis examines sputum by flow cytometry for five markers: TCPP, CD206, CD66b, CD3, and CD19. An algorithm uses the assay findings to report a likelihood of lung cancer, supporting evaluation of potential lung cancer. The result is a likelihood assessment rather than a tissue diagnosis. This code identifies the specific sputum-based flow cytometry analysis. The five markers are assessed together in the assay, and the algorithm produces the reported likelihood.
Medicare pays 0406U through the CLFS at one nationally set amount across states and localities, with no geographic or office/facility adjustment. The 2026 national CLFS amount is $760.00, unchanged from 2024 and 2025. CLFS payment is one amount per code nationwide.
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 0406U
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 0406U. 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 0406U: Medicare pays the test only from the CLFS.
0406U on the lab fee schedule since 2023
0406U · 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.
0406U compared with similar tests
- 88108Concentrated cytologyNon-gynecologic specimen$60.90–$93.84
- Use 88108 for cytology using a concentration technique with smears and interpretation. Use 0406U for the five-marker sputum flow cytometry assay and its algorithmic likelihood result.
- 88112Selective-enhancement cytologyNongynecologic specimens$58.60–$87.70
- 88112 describes cytology with selective cellular enhancement. It is a cytology preparation and interpretation service, not the five-marker flow cytometry analysis reported by 0406U.
- 88104Fluid cytologyDirect smear method$74.55–$114.37
- 88104 applies to smear cytology of eligible fluids, washings, or brushings. It describes cytology work, rather than the sputum flow cytometry assay reported under 0406U.
0406U billing questions
How does 0406U differ from sputum cytology?
0406U is a five-marker flow cytometry assay with an algorithmic lung cancer likelihood result. Cytopathology codes describe examination of prepared cells by cytology methods.
What specimen is used for 0406U?
The assay is performed on sputum and uses five markers to produce an algorithmic likelihood result.
What does 0406U identify?
It identifies a proprietary five-marker sputum flow cytometry analysis that reports an algorithmic likelihood of lung cancer.
How does Medicare pay 0406U?
Medicare pays it through the CLFS using one nationally set amount per code, with no geographic or office/facility adjustment.
How does 0406U differ from a tissue diagnosis?
The assay reports an algorithmic likelihood of lung cancer from sputum; it is not a tissue diagnosis.
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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