CPT code 0473U: Tumor sequencing, matched-normal analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Next-generation sequencing analyzes 648 genes in solid-tumor tissue against matched normal DNA to characterize tumor alterations, including genomic and biomarker findings.
Medicare pays $4,500.00 for 0473U 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
$4,500.00
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 0473U covers
This assay sequences DNA from a solid-tumor tissue specimen and compares the findings with DNA from a matched normal specimen obtained from blood or saliva. It examines 648 genes for sequence variants, insertions and deletions, copy-number changes, rearrangements, microsatellite instability, and tumor mutational burden. A molecular laboratory performs the sequencing and reports the assay findings as a solid-tumor genomic profile.
Report 0473U for this 648-gene tissue-based assay with matched-normal comparison, rather than for a narrower tumor assay or an inherited cancer-risk panel. Medicare pays the code under the CLFS at one national amount across states and localities, without geographic or office/facility adjustment. The 2026 national CLFS amount is $4,500.00, unchanged from 2024 and 2025. The code is paid through the CLFS only; it has no physician fee schedule payment or separately payable 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 0473U
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 0473U. 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 0473U: Medicare pays the test only from the CLFS.
0473U on the lab fee schedule since 2024
0473U · CLFS 2026 Q4 (current)
$4,500.00
Unchanged since Oct 1, 2024
Every change on file
- Oct 1, 2024 · CLFS 2024 Q4MAC-priced → $4,500.00
10 quarterly CLFS releases on file, first CLFS 2024 Q3. A code missing from a quarter wasn’t on that release.
0473U compared with similar tests
- 0471UKRAS/NRAS test35 variants in tissue$760.00
- 0471U is a colorectal cancer assay involving KRAS and NRAS variants. 0473U profiles 648 genes in solid-tumor tissue with matched-normal comparison.
- 0478UNSCLC gene testNine-gene DNA/RNA analysis$552.99
- 0478U is a DNA/RNA assay for non-small cell lung cancer. 0473U is the broader 648-gene solid-tumor assay.
- 0474UPan-cancer panel88 genes, germline$1,303.95
- 0474U is an inherited pancreatic cancer panel. 0473U analyzes solid-tumor tissue and compares it with matched normal DNA.
- 0475UProstate cancer panel23 genes, risk score$1,303.95
- 0475U is an inherited prostate cancer panel. 0473U is a solid-tumor assay, not an inherited cancer-risk panel.
0473U billing questions
When should 0473U be reported instead of a targeted tumor test?
Use 0473U for the 648-gene solid-tumor assay with matched-normal comparison. Codes such as 0471U and 0478U describe different, more focused tumor assays.
What specimens are compared?
The assay analyzes DNA from solid-tumor tissue and compares it with matched normal DNA from blood or saliva.
Is there a separately payable professional interpretation?
Medicare pays 0473U through the CLFS only; there is no separate physician fee schedule payment for this code.
Does Medicare use a different amount for office and facility testing?
No. The national CLFS amount applies across localities without an office-versus-facility payment difference.
How does 0473U differ from an inherited cancer panel?
0473U analyzes solid-tumor DNA and compares it with matched normal DNA. Codes such as 0474U and 0475U describe hereditary cancer panels.
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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