CPT code 81206: BCR-ABL1 test, major breakpoint2026 Medicare lab fee · Clinical Laboratory Fee Schedule
BCR-ABL1 major-breakpoint analysis detects the fusion associated with chronic myeloid leukemia and is used for diagnosis or disease monitoring.
Medicare pays $163.96 for 81206 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
$163.96
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 81206 covers
This molecular test analyzes the major-breakpoint BCR::ABL1 fusion, commonly associated with chronic myeloid leukemia (CML). It may be ordered to assess a suspected BCR::ABL1-positive leukemia or to monitor a patient with known CML. Peripheral blood and bone marrow are common specimens for this testing. Hospital and independent molecular laboratories perform the analysis and report the result to the ordering clinician.
Code 81206 covers major-breakpoint analysis whether the result is qualitative or quantitative. Select it for the major breakpoint rather than the minor or other breakpoint assay. Medicare pays this test through the Clinical Laboratory Fee Schedule (CLFS); it is excluded from the physician fee schedule. The 2026 national CLFS amount is $163.96, unchanged since 2020. The CLFS amount is the same nationwide, without locality or office/facility adjustment.
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 81206
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 81206. 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 81206 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81206 on the lab fee schedule since 2020
81206 · CLFS 2026 Q4 (current)
$163.96
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.
81206 compared with similar tests
- 81207BCR::ABL1 testMinor breakpoint$144.84
- Use 81207 for the minor BCR::ABL1 breakpoint; use 81206 for the major breakpoint.
- 81208BCR-ABL1 testOther breakpoint$214.62
- Use 81208 for analysis of another BCR::ABL1 breakpoint, not the major breakpoint reported under 81206.
- 88275Interphase ISH100–300 cells$51.19
- Code 88275 describes interphase in situ hybridization. Code 81206 describes molecular analysis specific to the BCR::ABL1 major breakpoint.
81206 billing questions
When should 81206 be selected instead of 81207 or 81208?
Select 81206 when the assay analyzes the BCR::ABL1 major breakpoint. Codes 81207 and 81208 represent the minor and other breakpoint analyses, respectively.
Does the code differ for qualitative and quantitative results?
No. Code 81206 covers major-breakpoint analysis reported qualitatively or quantitatively.
Is this test paid under the physician fee schedule?
No. Medicare pays 81206 through the CLFS, and the code is excluded from the physician fee schedule.
Is 81206 the same test as BCR-ABL1 FISH?
No. Code 81206 is molecular analysis of the major breakpoint; FISH uses in situ hybridization to assess chromosomal material. The method performed determines the code.
Does the CLFS amount vary by locality or site of service?
No. Medicare sets one national CLFS amount for 81206, with no locality or office/facility adjustment.
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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