CPT code 81235: EGFR testing, common variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
EGFR common-variant gene analysis supports molecular evaluation of non-small cell lung cancer and is reported for testing of the EGFR gene.
Medicare pays $324.58 for 81235 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
$324.58
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 81235 covers
This molecular pathology service analyzes the epidermal growth factor receptor (EGFR) gene for common variants. It is used in evaluating non-small cell lung cancer (NSCLC), where identifying EGFR alterations can help characterize the tumor. Examples include exon 19 deletions, L858R, T790M, G719A, G719S, and L861Q. The code describes common-variant analysis of EGFR, not testing across multiple genes. A molecular laboratory reports the findings for the ordering clinician.
Report 81235 for EGFR common-variant gene analysis. Medicare pays the test under the CLFS, and it is paid only through that schedule rather than the physician fee schedule. The 2026 national CLFS amount is $324.58, unchanged from 2020 through 2026. One national amount applies in every state and locality, with no geographic adjustment or office/facility payment difference.
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 81235
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 81235. 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 81235 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81235 on the lab fee schedule since 2020
81235 · CLFS 2026 Q4 (current)
$324.58
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.
81235 compared with similar tests
- 81445Tumor gene panel5–50 genes, DNA or DNA/RNA$597.91
- 81235 is for common-variant analysis of EGFR alone. Code 81445 describes a qualifying multigene solid-tumor panel.
- 81275KRAS testingExon 2 variants$193.25
- 81275 analyzes common KRAS variants, not EGFR. Select the code for the gene analyzed.
- 81210BRAF testV600 variant analysis$175.40
- 81210 analyzes common BRAF variants, not EGFR. It represents a different single-gene test.
81235 billing questions
When is 81235 used?
It is used for molecular analysis of common EGFR variants, including in the evaluation of non-small cell lung cancer.
Which EGFR variants are included?
Examples include exon 19 deletions, L858R, T790M, G719A, G719S, and L861Q.
Does 81235 describe a multigene cancer panel?
No. It describes common-variant analysis of the EGFR gene, rather than analysis across multiple genes.
Does 81235 measure EGFR protein expression?
No. It is a gene analysis, not an assessment of EGFR protein expression.
How does Medicare pay for 81235?
Medicare pays it under the CLFS, not the physician fee schedule. The CLFS amount is nationally priced, 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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