CPT code 81309: PIK3CA test, targeted sequence analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Targeted PIK3CA sequence analysis examines selected gene regions for molecular evaluation of breast or colorectal cancers, rather than full-gene sequencing.
Medicare pays $274.83 for 81309 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
$274.83
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 81309 covers
81309 identifies targeted sequence analysis of PIK3CA, a gene assessed in molecular testing of breast and colorectal cancers. The assay examines selected regions rather than the entire gene. Molecular diagnostic laboratories perform and report this analysis in oncology care. The code is specific to PIK3CA and does not describe sequencing of a broader gene panel.
Medicare pays 81309 under the CLFS at one national amount, with no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $274.83, unchanged from 2020 through 2026. The code is excluded from the physician fee schedule, so Medicare pays for the test through the CLFS. Report 81309 for targeted PIK3CA sequence analysis, not full-gene sequencing.
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 81309
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 81309. 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 81309 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81309 on the lab fee schedule since 2020
81309 · CLFS 2026 Q4 (current)
$274.83
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.
81309 compared with similar tests
- 81311NRAS variant testExons 2 and 3$295.79
- 81311 analyzes NRAS variants; 81309 analyzes targeted PIK3CA regions. Choose according to the gene tested.
- 81301MSI analysisMismatch repair markers$348.56
- 81301 evaluates microsatellite instability, a different tumor biomarker; 81309 is targeted PIK3CA sequence analysis.
- 81445Tumor gene panel5–50 genes, DNA or DNA/RNA$597.91
- 81445 describes a solid-tumor gene panel covering 5–50 genes; 81309 describes targeted analysis of PIK3CA.
- 81455Tumor genomic panel51+ genes, DNA or DNA/RNA$2,919.60
- 81455 describes a solid-tumor gene panel covering 51 or more genes; 81309 describes targeted analysis of PIK3CA.
81309 billing questions
What does 81309 analyze?
It reports targeted sequence analysis of PIK3CA, examining selected regions rather than the entire gene.
When might 81445 or 81455 be considered instead?
Those codes describe broader solid-tumor gene panels: 5–50 genes for 81445 and 51 or more genes for 81455. 81309 describes targeted PIK3CA analysis.
How does Medicare pay for 81309?
Medicare pays it under the CLFS at one national amount, without locality or office-versus-facility adjustment.
Does 81309 have physician fee schedule payment?
No. Medicare excludes 81309 from the physician fee schedule and pays for the test only through the CLFS.
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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