CPT code 81167: BRCA2 rearrangement test, full-gene copy-number analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Analyzes BRCA2 for large duplications or deletions when evaluating inherited breast and ovarian cancer risk.
Medicare pays $282.88 for 81167 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
$282.88
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 81167 covers
This test evaluates BRCA2 for large copy-number changes, including duplications or deletions involving the gene. It is used in hereditary cancer evaluation when inherited BRCA2-related risk is assessed. Unlike sequence analysis, it targets large gene rearrangements rather than small sequence variants.
Report 81167 for full-gene BRCA2 duplication/deletion analysis. It is distinct from BRCA2 sequence analysis and from assays covering both BRCA1 and BRCA2. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $282.88, unchanged from 2020 through 2026, and applies across localities without geographic or office/facility adjustment. The physician fee schedule excludes this test by statute.
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 81167
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 81167. 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 81167 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81167 on the lab fee schedule since 2020
81167 · CLFS 2026 Q4 (current)
$282.88
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.
81167 compared with similar tests
- 81162BRCA1/2 testingFull sequence and rearrangements$1,824.88
- 81162 includes BRCA1 and BRCA2 full sequencing and duplication/deletion analysis. 81167 is limited to BRCA2 duplication/deletion analysis.
- 81164BRCA analysisFull duplication/deletion analysis$584.23
- 81164 evaluates full-gene duplications or deletions in both BRCA1 and BRCA2; 81167 evaluates BRCA2 alone.
- 81165BRCA1 sequencingFull gene sequence$282.88
- 81165 is full-gene BRCA1 sequence analysis. 81167 evaluates BRCA2 duplications or deletions.
- 81166BRCA1 analysisFull duplication/deletion$301.35
- 81166 analyzes full-gene duplications or deletions in BRCA1, while 81167 performs that analysis for BRCA2.
81167 billing questions
Does 81167 include BRCA2 sequence analysis?
No. It evaluates large BRCA2 duplications or deletions; BRCA2 sequence analysis is a separate service.
How does 81167 differ from 81166?
81167 analyzes BRCA2 for full-gene duplications or deletions. 81166 performs the corresponding analysis for BRCA1.
When is 81167 preferable to a BRCA1-and-BRCA2 assay?
Use 81167 when the performed analysis is limited to BRCA2. Codes 81162 and 81164 cover both genes, with 81162 also including sequence analysis.
How does Medicare pay 81167?
Medicare pays it under the CLFS at one national amount that applies across localities, without an office or facility difference. The physician fee schedule excludes the test by statute.
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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