CPT code 0409U: Tumor profiling, plasma DNA and RNA2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This plasma-based next-generation sequencing assay profiles solid tumor DNA and RNA to identify genomic findings that may inform cancer treatment decisions.
Medicare pays $2,919.60 for 0409U 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
$2,919.60
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 0409U covers
This proprietary oncology assay uses next-generation sequencing on plasma to profile circulating tumor DNA and RNA from a solid tumor. Its DNA portion covers 80 genes, and the report identifies mutations and clinically actionable findings, including sequence changes, copy-number alterations, microsatellite instability, and fusions. Oncologists may order plasma profiling when genomic information is needed to guide treatment decisions and a blood-based tumor assessment is selected. A molecular laboratory performs the sequencing and reports the findings.
Report the assay as one service rather than separate entries for individual genes or findings. Medicare pays this code only under the CLFS. The 2026 national CLFS amount is $2,919.60, the same in every state and locality and in office and facility settings; it has been unchanged since 2024. The code has no separate physician fee schedule payment for interpretation.
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 0409U
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 0409U. 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 0409U: Medicare pays the test only from the CLFS.
0409U on the lab fee schedule since 2023
0409U · CLFS 2026 Q4 (current)
$2,919.60
Unchanged since Jan 1, 2024
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $2,919.60
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0409U compared with similar tests
- 81445Tumor gene panel5–50 genes, DNA or DNA/RNA$597.91
- This general solid tumor DNA panel covers 5–50 genes. The code here identifies a proprietary plasma assay with an 80-gene DNA component and RNA analysis.
- 81455Tumor genomic panel51+ genes, DNA or DNA/RNA$2,919.60
- This general solid tumor DNA panel covers 51 or more genes. Choose the code that matches the assay and coding pathway actually performed, rather than comparing gene count alone.
- 81456RNA tumor panel51 or more genes$2,919.60
- This general solid tumor panel analyzes RNA across 51 or more genes. Code 0409U identifies a proprietary plasma assay that analyzes both DNA and RNA.
0409U billing questions
When is this code appropriate instead of a general tumor sequencing panel?
Use it when the assay performed is this specific proprietary plasma DNA-and-RNA test. A general panel code describes a different coding pathway and should not be substituted solely because the test examines many genes.
What specimen does the assay use?
The assay sequences DNA and RNA from plasma. The reported service is not a tissue-based tumor panel.
Are genes or individual findings billed as separate units?
The CLFS payment is one amount per code. The assay's gene count and reported findings are part of the service, not separate entries under this code.
Does Medicare pay a separate physician interpretation fee?
No separate physician fee schedule payment is associated with this code; Medicare pays it under the CLFS.
What should the record support?
Document the solid tumor context, the plasma specimen, the assay performed, and the resulting genomic report.
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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