CPT code 81227: CYP2C9 test, common variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
CYP2C9 gene analysis detects common variants that can affect drug metabolism, often to inform medication selection or dosing, including warfarin management.
Medicare pays $174.81 for 81227 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
$174.81
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 81227 covers
This molecular test analyzes the CYP2C9 gene for common variants, including examples such as *2, *3, *5, and *6. CYP2C9 influences the metabolism of several medications. Clinicians may order the analysis when pharmacogenetic information could inform medication selection or dosing; warfarin management is a familiar use. A laboratory performs the genetic analysis, with results interpreted in the context of the patient’s medication and clinical situation.
Medicare pays the test through the Clinical Laboratory Fee Schedule (CLFS); it is nationally priced, with the same amount across localities and no office-versus-facility difference. The 2026 national CLFS amount is $174.81, unchanged since 2020. The test is paid only through the CLFS, not the 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 81227
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 81227. 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 81227 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81227 on the lab fee schedule since 2020
81227 · CLFS 2026 Q4 (current)
$174.81
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.
81227 compared with similar tests
- 81225CYP2C19 testCommon variants$291.36
- Choose 81227 for common CYP2C9 variants; 81225 is the corresponding common-variant analysis for CYP2C19.
- 81226CYP2D6 testingCommon CYP2D6 variants$450.91
- 81227 analyzes CYP2C9, while 81226 analyzes CYP2D6. Select according to the gene tested, not simply because both relate to drug metabolism.
- 81230CYP3A4 gene testCommon variants$174.81
- 81227 is for CYP2C9 common variants; 81230 is for CYP3A4 common variants.
81227 billing questions
When is 81227 the appropriate genetic test?
Use it for analysis of common CYP2C9 variants. It is not the code for testing CYP2C19, CYP2D6, CYP3A4, or another drug-metabolism gene.
Which CYP2C9 variants does this analysis cover?
It covers common variants, with examples including *2, *3, *5, and *6.
Can this test inform warfarin management?
Yes. CYP2C9 results may inform warfarin dosing decisions, alongside the patient’s clinical circumstances and other relevant information.
How does Medicare pay for 81227?
Medicare pays it through the CLFS at a national rate that is the same across localities and settings. The test is paid only through the CLFS.
What should the record support?
Document the clinical reason for CYP2C9 testing and the medication-related question the result is intended to inform.
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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