CPT code 0407U: CKD risk assay, diabetic kidney disease2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A plasma assay combines three biomarkers with clinical data to report progressive kidney function decline risk for people with diabetic chronic kidney disease.
Medicare pays $950.00 for 0407U 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
$950.00
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 7 sections
What 0407U covers
This proprietary laboratory analysis estimates risk of progressive kidney function decline in diabetic chronic kidney disease. It measures plasma soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, and kidney injury molecule 1 by multiplex electrochemiluminescent immunoassay and combines those results with clinical data in an algorithm. The reported output is a risk assessment, not three standalone biomarker results.
Report 0407U for the combined assay. Medicare pays it only through the CLFS, with no physician fee schedule payment. The 2026 national CLFS amount is $950.00, unchanged from 2024 and 2025. The same national amount applies across states and localities, without an office-versus-facility adjustment.
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 0407U
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 0407U. 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 0407U: Medicare pays the test only from the CLFS.
0407U on the lab fee schedule since 2023
0407U · CLFS 2026 Q4 (current)
$950.00
Unchanged since Jan 1, 2024
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $950.00
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0407U compared with similar tests
- 80069Renal panelKidney-focused chemistry panel$8.68
- The renal function panel reports a group of chemistry tests used to assess kidney function; 0407U combines plasma biomarkers and clinical data to report progression risk in diabetic CKD.
- 82043Urine albuminQuantitative measurement$5.78
- This code reports urine albumin measurement. It is not the plasma biomarker-and-algorithm assay reported with 0407U.
- 82570Urine creatinineUrine specimen$5.18
- This code reports urine creatinine measurement, often used in urine albumin assessment. It does not produce the diabetic CKD progression-risk result of 0407U.
0407U billing questions
What specimen and method does this assay use?
It uses plasma and a multiplex electrochemiluminescent immunoassay to measure sTNFR1, sTNFR2, and KIM-1.
Does 0407U report three separate biomarker tests?
No. The three measurements are combined with clinical data in an algorithm that reports risk of progressive kidney function decline.
How does 0407U differ from a renal function panel?
A renal function panel reports a group of chemistry tests; 0407U reports an algorithm-based progression-risk result using plasma biomarkers and clinical data.
How does Medicare pay 0407U?
Medicare pays the code through the CLFS only; there is no physician fee schedule payment for 0407U.
Does the CLFS amount vary by locality or setting?
No. One national amount applies across states and localities, with no office-versus-facility adjustment.
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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