CPT code 81292: MLH1 testing, full sequence2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Full-sequence analysis of MLH1 supports evaluation for Lynch syndrome in patients with a personal or family history suggestive of inherited cancer risk.
Medicare pays $675.40 for 81292 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
$675.40
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 81292 covers
A molecular laboratory analyzes the full sequence of MLH1, a mismatch-repair gene associated with Lynch syndrome, also called hereditary nonpolyposis colorectal cancer. Clinicians may order the test when a patient’s personal or family history of colorectal, endometrial, or other Lynch syndrome-associated cancers raises concern for an inherited MLH1 variant. Results can inform genetic counseling and assessment of inherited cancer risk.
Report 81292 for full-sequence analysis, rather than targeted testing for known MLH1 variants or analysis limited to gene duplications or deletions. Medicare pays the test only through the CLFS; the 2026 national amount is $675.40, unchanged since 2020. One amount applies across states and localities, with no office-versus-facility 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 81292
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 81292. 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 81292 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81292 on the lab fee schedule since 2020
81292 · CLFS 2026 Q4 (current)
$675.40
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.
81292 compared with similar tests
- 81293MLH1 variant testKnown familial variants$331.00
- 81292 analyzes the full MLH1 sequence; 81293 targets known MLH1 variants, including a variant identified in a family.
- 81294MLH1 analysisDuplication and deletion variants$202.40
- 81292 is full-sequence analysis, while 81294 addresses MLH1 duplication or deletion variants.
- 81295MSH2 testingFull gene sequence$381.70
- Both are full-sequence tests, but 81292 analyzes MLH1 and 81295 analyzes MSH2.
81292 billing questions
When should 81292 be used instead of 81293?
Use 81292 for full-sequence MLH1 analysis. Code 81293 is for testing known MLH1 variants, such as a variant already identified in the family.
How does 81292 differ from 81294?
81292 represents full-sequence analysis. Code 81294 is for MLH1 duplication or deletion variant analysis.
What should the documentation show?
Documentation should identify MLH1 testing and the full-sequence scope, distinguishing it from known-variant testing or duplication/deletion analysis.
Does Medicare pay 81292 under the physician fee schedule?
No. Medicare pays this test through the CLFS, with one national amount applying across localities and 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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