CPT code 81225: CYP2C19 test, common variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
CYP2C19 genotyping identifies common variants that affect drug metabolism, often to inform clopidogrel treatment decisions.
Medicare pays $291.36 for 81225 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
$291.36
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 7 sections
What 81225 covers
This molecular test analyzes common variants in CYP2C19, a gene involved in drug metabolism. Examples include *2, *3, *4, *8, and *17. CYP2C19 differences can affect how medications such as clopidogrel are metabolized, so clinicians may order testing when considering clopidogrel therapy, including in cardiovascular care. Clinical laboratories perform and report the gene analysis for treating clinicians.
Report the common-variant gene analysis under 81225. Medicare pays the test only through the CLFS; it is excluded from physician fee schedule payment. The 2026 national CLFS amount is $291.36, unchanged since 2020. One national amount applies across states and localities, without geographic or office/facility adjustment. No physician interpretation component is separately payable under the physician fee schedule for this code.
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 81225
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 81225. 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 81225 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81225 on the lab fee schedule since 2020
81225 · CLFS 2026 Q4 (current)
$291.36
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.
81225 compared with similar tests
- 81226CYP2D6 testingCommon CYP2D6 variants$450.91
- Use 81225 for CYP2C19 analysis and 81226 for CYP2D6 analysis. The genes are distinct and inform different drug-metabolism questions.
- 81227CYP2C9 testCommon variants$174.81
- 81225 analyzes CYP2C19, while 81227 analyzes CYP2C9. Choose based on the gene tested, not simply because both are CYP assays.
- 81230CYP3A4 gene testCommon variants$174.81
- 81225 is for CYP2C19; 81230 is for CYP3A4. Each represents analysis of a different drug-metabolizing gene.
81225 billing questions
When is CYP2C19 testing considered for clopidogrel therapy?
A clinician may order it when CYP2C19-related differences in clopidogrel metabolism are relevant to treatment planning, often in cardiovascular care. The result supports clinical decision-making.
How does 81225 differ from 81226?
81225 analyzes CYP2C19; 81226 analyzes CYP2D6. They assess different drug-metabolizing genes and are not interchangeable.
Is a physician interpretation billed with modifier 26?
The test is paid only through the CLFS and is excluded from the physician fee schedule, so there is no separately payable physician interpretation component under that schedule.
Which Medicare payment schedule applies to 81225?
Medicare pays 81225 through the CLFS. One national amount applies across states and localities, with no office or 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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