CPT code 81162: BRCA1/2 testing, full sequence and rearrangements2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Combined BRCA1 and BRCA2 testing examines complete gene sequences and large rearrangements to assess inherited breast and ovarian cancer risk.
Medicare pays $1,824.88 for 81162 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
$1,824.88
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 81162 covers
This laboratory analysis examines the full sequences of BRCA1 and BRCA2 and looks for large gene rearrangements, including deletions and duplications. It is used in hereditary cancer risk evaluation when a clinician is assessing inherited susceptibility to breast or ovarian cancer. Molecular diagnostic laboratories perform the analysis; ordering clinicians may include oncologists, genetic counselors, and other providers managing hereditary cancer risk. Results can help identify inherited variants relevant to patient and family risk assessment.
Report this code when the analysis covers both full gene sequencing and full duplication/deletion analysis for BRCA1 and BRCA2. It represents the combined scope, rather than sequencing alone or rearrangement analysis alone. Medicare pays it through the CLFS, with one national amount across localities and no office-versus-facility difference. The 2026 national CLFS amount is $1,824.88, unchanged since 2020. The test is paid only from the CLFS, not the physician fee schedule.
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 81162
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 81162. 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 81162 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81162 on the lab fee schedule since 2020
81162 · CLFS 2026 Q4 (current)
$1,824.88
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.
81162 compared with similar tests
- 81163BRCA testingBoth genes, sequence analysis$468.00
- Use 81163 for full BRCA1 and BRCA2 sequencing alone. Use 81162 when the reported work also includes full duplication/deletion analysis.
- 81164BRCA analysisFull duplication/deletion analysis$584.23
- Use 81164 for full BRCA1 and BRCA2 duplication/deletion analysis alone. Code 81162 also covers full sequencing of both genes.
- 81165BRCA1 sequencingFull gene sequence$282.88
- 81165 is limited to full BRCA1 sequencing. Code 81162 covers both BRCA1 and BRCA2 and includes sequencing plus duplication/deletion analysis.
- 81166BRCA1 analysisFull duplication/deletion$301.35
- 81166 is limited to full BRCA1 duplication/deletion analysis. Code 81162 includes that analysis for both BRCA genes along with full sequencing.
81162 billing questions
When should 81162 be chosen over 81163 or 81164?
Use 81162 when the reported analysis includes full sequencing and full duplication/deletion analysis for both BRCA1 and BRCA2. Codes 81163 and 81164 describe those analysis scopes separately.
Is 81162 for one gene or both genes?
It covers the combined analysis of BRCA1 and BRCA2. For testing limited to one gene, select the code that matches that gene and the analysis performed.
How many units should be reported?
81162 describes the combined analysis of both genes by full sequencing and full duplication/deletion analysis.
How does Medicare pay for this test?
Medicare pays 81162 under the CLFS using one national amount. The payment is the same across localities and does not vary between office and facility settings.
What documentation supports reporting 81162?
Documentation should identify BRCA1 and BRCA2 testing and support that both full sequencing and full duplication/deletion analysis were performed.
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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