CPT code 0480U: CSF pathogen sequencing, DNA and RNA metagenomic NGS2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports cerebrospinal fluid metagenomic sequencing with bioinformatic analysis when the assay identifies an infectious pathogen across multiple organism types.
Medicare pays $2,126.20 for 0480U 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
$2,126.20
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 0480U covers
The assay analyzes cerebrospinal fluid with DNA and RNA next-generation sequencing and bioinformatic analysis to identify pathogens. Its infectious-disease scope includes bacteria, viruses, fungi, and parasites, and the service is characterized by positive pathogen identification. It may be used when evaluation of suspected central nervous system infection calls for broad pathogen identification from CSF. A clinical laboratory performs the molecular testing; clinicians interpret findings with the clinical picture.
Report 0480U for the described CSF assay, which includes sequencing and bioinformatic analysis. Medicare pays the code through the CLFS. The 2026 national CLFS amount is $2,126.20, unchanged from 2025. One national amount applies in every state and locality, without geographic adjustment or an office or facility difference. The code is paid only through the CLFS, with no separate 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 0480U
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 0480U. 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 0480U: Medicare pays the test only from the CLFS.
0480U on the lab fee schedule since 2024
0480U · CLFS 2026 Q4 (current)
$2,126.20
Unchanged since Jan 1, 2025
Every change on file
- Jan 1, 2025 · CLFS 2025 Q1MAC-priced → $2,126.20
9 quarterly CLFS releases on file, first CLFS 2024 Q4. A code missing from a quarter wasn’t on that release.
0480U compared with similar tests
- 0483UGonorrhea resistancegyrA S91F mutation$35.09
- 0483U is a targeted bacterial gyrA S91F point-mutation assay. 0480U is the broader CSF metagenomic sequencing service with positive pathogen identification.
- 0484UM. genitalium resistanceMacrolide resistance probability$35.09
- 0484U targets a 23S rRNA point mutation, whereas 0480U uses metagenomic DNA and RNA sequencing to identify pathogens in CSF.
- 87798Infectious agent testAmplified probe, each organism$35.09
- 87798 reports nucleic acid detection for an infectious agent per organism. 0480U describes CSF metagenomic sequencing with bioinformatic analysis and positive pathogen identification.
0480U billing questions
When is 0480U appropriate instead of an organism-specific molecular test?
0480U describes CSF metagenomic DNA and RNA sequencing with positive pathogen identification. An organism-specific test addresses a narrower target or question.
Does 0480U include sequencing and bioinformatic analysis?
Yes. Both are elements of the assay described by 0480U.
What specimen is associated with 0480U?
The assay is for cerebrospinal fluid.
Does Medicare pay a separate physician interpretation for 0480U?
The code is paid through the CLFS, with no separate physician fee schedule payment for this service.
What result is associated with this code?
The service is characterized by positive pathogen identification through metagenomic sequencing and bioinformatic analysis.
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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