CPT code 81226: CYP2D6 testing, common CYP2D6 variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
CYP2D6 common-variant testing analyzes drug-metabolism genetics to help clinicians assess medication response and select or adjust therapy.
Medicare pays $450.91 for 81226 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
$450.91
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 81226 covers
Laboratories analyze DNA for common CYP2D6 variants, which can affect the activity of an enzyme involved in metabolizing many medications. Clinicians may order pharmacogenetic testing when medication selection or dosing could be informed by a patient's inherited drug-metabolism profile. Results can support interpretation of predicted CYP2D6 metabolizer status. The common-variant analysis includes variants such as *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, and *41, as well as certain increased-copy forms. Molecular laboratories perform and report the genetic analysis for ordering clinicians.
Medicare pays 81226 only through the CLFS. The 2026 national CLFS amount is $450.91, unchanged since 2020; one amount applies in every state and locality, with no office or facility difference. The test is excluded from the physician fee schedule 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 81226
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 81226. 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 81226 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81226 on the lab fee schedule since 2020
81226 · CLFS 2026 Q4 (current)
$450.91
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.
81226 compared with similar tests
- 81225CYP2C19 testCommon variants$291.36
- 81225 analyzes CYP2C19 variants; use 81226 for CYP2D6 variants. The genes are distinct, even when both are assessed for medication management.
- 81227CYP2C9 testCommon variants$174.81
- 81227 analyzes CYP2C9 variants, not CYP2D6. Select the code for the gene analyzed.
- 81230CYP3A4 gene testCommon variants$174.81
- 81230 is for CYP3A4 variant analysis. It does not represent CYP2D6 testing.
81226 billing questions
What does 81226 analyze?
It analyzes common variants in CYP2D6, a gene involved in metabolizing many medications. Results can support interpretation of predicted CYP2D6 metabolizer status.
How is 81226 different from 81225?
81226 analyzes CYP2D6; 81225 analyzes CYP2C19. They assess different drug-metabolism genes.
Does 81226 include CYP2C9 testing?
No. CYP2D6 and CYP2C9 are different genes; CYP2C9 analysis is reported with 81227 when performed.
What does the common-variant scope include?
The analysis covers common CYP2D6 variants, including examples such as *2, *4, *10, and *41, as well as certain increased-copy forms.
How does Medicare pay for 81226?
Medicare pays it through the CLFS at one national amount that applies across localities and in office or facility settings.
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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