CPT code 0475U: Prostate cancer panel, 23 genes, risk score2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This hereditary prostate cancer assay evaluates 23 genes and reports pathologic mutations with a genetic risk score for inherited-risk assessment.
Medicare pays $1,303.95 for 0475U 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
$1,303.95
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2025
- 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 0475U covers
0475U represents a proprietary hereditary prostate cancer assay that evaluates 23 genes using next-generation sequencing. The laboratory reports pathologic mutations with a genetic risk score for prostate cancer. Sanger sequencing and methods for assessing deletions or duplications, including MLPA or array comparative genomic hybridization, are used when indicated. The result supports evaluation of inherited prostate cancer risk and is reported by the testing laboratory to the ordering clinician.
Report one code for the 23-gene assay rather than separate units for each gene. Medicare pays 0475U only under the CLFS at a single national amount, without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $1,303.95, unchanged from 2025.
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 0475U
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 0475U. 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 0475U: Medicare pays the test only from the CLFS.
0475U on the lab fee schedule since 2024
0475U · CLFS 2026 Q4 (current)
$1,303.95
Unchanged since Jan 1, 2025
Every change on file
- Jan 1, 2025 · CLFS 2025 Q1MAC-priced → $1,303.95
10 quarterly CLFS releases on file, first CLFS 2024 Q3. A code missing from a quarter wasn’t on that release.
0475U compared with similar tests
- 0474UPan-cancer panel88 genes, germline$1,303.95
- 0474U is a hereditary pancreatic cancer panel; 0475U is the 23-gene hereditary prostate cancer assay.
- 81307PALB2 testFull gene sequence$676.50
- 81307 analyzes HOXB13 rather than reporting the 23-gene prostate cancer panel and risk score.
- 81162BRCA1/2 testingFull sequence and rearrangements$1,824.88
- 81162 focuses on BRCA1 and BRCA2, while 0475U reports a 23-gene hereditary prostate cancer assay and genetic risk score.
0475U billing questions
How does 0475U differ from 0474U?
0475U is a 23-gene hereditary prostate cancer assay. 0474U is a separate hereditary pancreatic cancer panel.
Does the assay include deletion and duplication analysis?
Methods for assessing deletions and duplications, including MLPA or array comparative genomic hybridization, are used when indicated as part of the panel.
Should 0475U be reported once for each gene?
No. Report one code for the 23-gene assay, not separate units for each gene analyzed.
Is physician interpretation paid separately?
Medicare pays 0475U through the CLFS only; no physician fee schedule payment is associated with the code.
Does Medicare pay a different amount by locality or setting?
No. Medicare uses one national CLFS amount, with no geographic or 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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