CPT code 81319: PMS2 analysis, duplication and deletion variants2026 Medicare lab fee · Clinical Laboratory Fee Schedule
PMS2 duplication and deletion analysis evaluates gene changes used in hereditary cancer-risk assessment, including evaluation for Lynch syndrome.
Medicare pays $203.50 for 81319 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
$203.50
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 81319 covers
This molecular genetic analysis evaluates PMS2 for gene duplications and deletions, structural changes distinct from sequencing the gene or testing a known familial variant. It may be used in hereditary cancer-risk evaluation for Lynch syndrome, also called hereditary nonpolyposis colorectal cancer. The laboratory analyzes and reports PMS2 duplication and deletion findings.
Report 81319 for PMS2 duplication and deletion analysis, rather than full-sequence analysis (81317) or testing for a known familial PMS2 variant (81318). Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $203.50 and has been unchanged since 2020; one amount applies across localities, without an office or facility payment difference. The test is excluded from 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 81319
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 81319. 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 81319 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81319 on the lab fee schedule since 2020
81319 · CLFS 2026 Q4 (current)
$203.50
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.
81319 compared with similar tests
- 81317PMS2 sequencingFull gene sequence$676.50
- 81317 is for full-sequence analysis of PMS2. Choose 81319 when the analysis targets duplication and deletion variants.
- 81318PMS2 testingKnown familial variants$331.00
- 81318 tests for a specific known familial PMS2 variant; 81319 evaluates PMS2 for duplication and deletion changes.
- 81294MLH1 analysisDuplication and deletion variants$202.40
- 81294 evaluates MLH1 for duplication and deletion changes. 81319 evaluates PMS2 for those changes.
81319 billing questions
When is 81319 different from 81317?
81319 is for PMS2 duplication and deletion analysis. Use 81317 when the service is full-sequence analysis instead.
How does 81319 differ from 81318?
81318 tests for a known familial PMS2 variant. 81319 evaluates PMS2 for duplications and deletions.
What does 81319 analyze?
It analyzes PMS2 for gene duplications and deletions, rather than sequencing the gene or testing a known familial variant.
How does Medicare pay for 81319?
Medicare pays it through the CLFS only. The same national amount applies across localities, without an office or 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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