CPT code 0476U: Psychiatric PGx, 14 genes, CYP2D6 copy number2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Pharmacogenomic testing genotypes 14 genes and analyzes CYP2D6 copy number to report medication-relevant phenotypes for psychiatric treatment.
Medicare pays $416.78 for 0476U 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
$416.78
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 0476U covers
This psychiatric pharmacogenomic assay genotypes 14 genes and analyzes CYP2D6 copy-number variation, with reported phenotypes related to drug metabolism. It is associated with medication management for conditions such as major depressive disorder, generalized anxiety disorder, ADHD, and schizophrenia. Specimen types include whole blood and buccal swab. The laboratory reports findings for clinician use in psychiatric treatment.
Report 0476U when the performed assay matches this 14-gene and CYP2D6 copy-number scope; retain documentation identifying the assay and specimen. Medicare pays 0476U through the CLFS at one national amount across localities, without geographic or office/facility adjustment. The 2026 national CLFS amount is $416.78, unchanged from 2025. The code is paid through the CLFS only and has no physician fee schedule payment.
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 0476U
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 0476U. 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 0476U: Medicare pays the test only from the CLFS.
0476U on the lab fee schedule since 2024
0476U · CLFS 2026 Q4 (current)
$416.78
Unchanged since Jan 1, 2025
Every change on file
- Jan 1, 2025 · CLFS 2025 Q1MAC-priced → $416.78
9 quarterly CLFS releases on file, first CLFS 2024 Q4. A code missing from a quarter wasn’t on that release.
0476U compared with similar tests
- 0477UPsychiatric pharmacogenomics14 genes plus CYP2D6 copy number$416.78
- 0476U includes CYP2D6 copy-number variant analysis and reports phenotypes. Match 0477U to its own assay and code description.
- 81226CYP2D6 testingCommon CYP2D6 variants$450.91
- 81226 applies to CYP2D6 genotyping alone; 0476U describes a broader 14-gene assay that also includes CYP2D6 copy-number analysis.
0476U billing questions
What does 0476U report?
It reports pharmacogenomic genotyping of 14 genes, CYP2D6 copy-number variant analysis, and associated phenotypes.
Which specimens are associated with this assay?
The assay is described for whole blood and buccal swab. Retain documentation identifying the specimen and assay performed.
How should 0476U be distinguished from 0477U?
0476U is identified by 14-gene genotyping with CYP2D6 copy-number variant analysis and reported phenotypes. Match 0477U to its own assay and code description rather than assuming the codes are interchangeable.
Does Medicare pay 0476U through the physician fee schedule?
No. Medicare pays 0476U through the CLFS only.
Does the CLFS amount vary by locality?
No. Medicare pays one national CLFS amount for 0476U across localities, without geographic or office/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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