CPT code 81025: Urine pregnancy test, visual color method2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A qualitative urine hCG test read by comparing test color with a reference, reported when pregnancy status is evaluated.
Medicare pays $8.61 for 81025 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
$8.61
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- 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 81025 covers
This test detects human chorionic gonadotropin (hCG) in urine and provides a qualitative pregnancy result by interpreting a color change against the test’s reference. It is commonly ordered in physician offices, clinics, and outpatient settings when pregnancy status is being assessed, including before a treatment or procedure. Office or laboratory personnel may perform the test; it is not a quantitative hCG measurement.
Report the code for the urine pregnancy test performed. Medicare pays it through the Clinical Laboratory Fee Schedule (CLFS), at one national amount across localities and without an office-versus-facility difference. The 2026 national CLFS amount is $8.61, unchanged since 2020. Medicare pays this test only through the CLFS.
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 81025
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 81025. 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.
Excluded from the physician fee schedule
The physician fee schedule lists 81025 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81025 on the lab fee schedule since 2020
81025 · CLFS 2026 Q4 (current)
$8.61
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
81025 compared with similar tests
- 84703Pregnancy testQualitative hCG$7.52
- 84703 reports qualitative hCG testing. Choose 81025 when the qualitative pregnancy test is performed on urine using a visual color method.
- 84702hCG testQuantitative level$15.05
- 84702 reports quantitative hCG testing, while 81025 reports a qualitative pregnancy result from urine.
- 81003UrinalysisAutomated, without microscopy$2.25
- 81003 reports an automated urinalysis without microscopy, not a pregnancy test. Use 81025 for the urine pregnancy test.
81025 billing questions
When should 81025 be selected instead of 84703?
Use 81025 for a qualitative pregnancy test performed on urine using a visual color method. Code 84703 reports qualitative hCG testing; select the code that matches the test performed.
Does 81025 report a quantitative hCG result?
No. It reports a qualitative urine pregnancy test, not a measured hCG concentration.
Can a urinalysis be reported at the same encounter?
A separately performed urinalysis may be reported when it is independently ordered and performed; it is not the pregnancy test itself.
How does Medicare pay for 81025?
Medicare pays 81025 only through the CLFS, using one national amount across localities and without an office or facility payment difference.
How does 81025 differ from 84702?
81025 reports a qualitative pregnancy test on urine. Code 84702 reports quantitative hCG testing.
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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