CPT code 81164: BRCA analysis, full duplication/deletion analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Full BRCA1 and BRCA2 duplication/deletion analysis detects large gene rearrangements during evaluation of inherited breast and ovarian cancer risk.
Medicare pays $584.23 for 81164 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
$584.23
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 81164 covers
This molecular test evaluates BRCA1 and BRCA2 for large rearrangements caused by gene duplications or deletions. It is used in hereditary breast and ovarian cancer risk assessment. Clinical molecular laboratories perform the analysis as part of genetic testing for inherited cancer risk.
Report 81164 for combined full duplication/deletion analysis of both genes. The analysis detects large rearrangements; it is distinct from full gene sequencing, which examines sequence-level variants. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $584.23, unchanged since 2020. One national amount applies across states and localities, with no geographic adjustment or office/facility difference. The code is excluded from the Medicare 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 81164
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 81164. 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 81164 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81164 on the lab fee schedule since 2020
81164 · CLFS 2026 Q4 (current)
$584.23
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.
81164 compared with similar tests
- 81162BRCA1/2 testingFull sequence and rearrangements$1,824.88
- 81162 combines full sequencing with duplication/deletion analysis for both genes. 81164 is limited to full duplication/deletion analysis.
- 81163BRCA testingBoth genes, sequence analysis$468.00
- 81163 is full sequencing of BRCA1 and BRCA2. Choose 81164 when the analysis targets large duplications or deletions.
- 81166BRCA1 analysisFull duplication/deletion$301.35
- 81166 covers full duplication/deletion analysis of BRCA1 alone; 81164 covers both BRCA1 and BRCA2.
- 81167BRCA2 rearrangement testFull-gene copy-number analysis$282.88
- 81167 covers full duplication/deletion analysis of BRCA2 alone; 81164 covers both BRCA1 and BRCA2.
81164 billing questions
When should 81164 be selected instead of 81162?
81164 reports full duplication/deletion analysis of BRCA1 and BRCA2. 81162 covers full sequencing together with duplication/deletion analysis of both genes.
Does 81164 cover both BRCA genes?
Yes. The code represents full duplication/deletion analysis of BRCA1 and BRCA2 together, not a separate code for each gene.
How does 81164 differ from 81163?
81164 targets large duplications or deletions in both genes. 81163 reports full sequencing of both genes.
Should 81166 or 81167 be reported instead?
Those codes describe full duplication/deletion analysis of BRCA1 alone or BRCA2 alone, respectively. Use 81164 for the combined analysis of both genes.
How does Medicare pay for 81164?
Medicare pays it under the CLFS at one national amount that applies in every locality and does not vary by office or facility setting. The test is paid only through the CLFS.
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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