CPT code 81296: MSH2 testing, known familial variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Targeted MSH2 testing identifies a previously established familial variant in patients evaluated for inherited Lynch syndrome.
Medicare pays $337.73 for 81296 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
$337.73
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 81296 covers
81296 covers targeted analysis of known familial variants in MSH2, a gene associated with Lynch syndrome (hereditary nonpolyposis colorectal cancer). It is selected when a specific familial MSH2 variant is already known and testing is directed at that finding, such as testing a relative for the variant. Clinical laboratories analyze patient DNA and report the result. This is narrower than sequencing the full MSH2 gene and differs from MSH2 deletion/duplication analysis.
Report the code for targeted known-variant MSH2 analysis. Medicare pays 81296 only through the Clinical Laboratory Fee Schedule (CLFS), with one national amount applying across states and localities and no office-versus-facility payment difference. The 2026 national CLFS amount is $337.73, unchanged from 2020 through 2026.
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 81296
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 81296. 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 81296 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81296 on the lab fee schedule since 2020
81296 · CLFS 2026 Q4 (current)
$337.73
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.
81296 compared with similar tests
- 81295MSH2 testingFull gene sequence$381.70
- 81296 targets known familial MSH2 variants; 81295 is used for MSH2 full-gene sequencing.
- 81297MSH2 analysisDuplication and deletion variants$213.30
- 81296 is targeted known-variant analysis. 81297 addresses MSH2 deletion/duplication variants.
- 81299MSH6 testingKnown familial variants$308.00
- Both are known familial variant tests, but 81296 is for MSH2 and 81299 is for MSH6.
81296 billing questions
When should 81296 be selected instead of 81295?
Use 81296 when testing targets a known familial MSH2 variant. Code 81295 describes MSH2 full-gene sequencing.
How does 81296 differ from 81297?
81296 tests for known familial MSH2 variants. Code 81297 describes MSH2 deletion/duplication variant analysis.
Does the number of family members determine which code applies?
The code describes targeted analysis of a known familial MSH2 variant; it is not selected based on the number of relatives.
What clinical detail supports selecting 81296?
The analysis targets a specific known familial variant in MSH2.
How does Medicare pay for 81296?
Medicare pays 81296 through the CLFS at one national amount across localities, with no office-versus-facility payment difference.
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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