CPT code 81415: Exome analysis, initial sequence analysis2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Exome sequence analysis evaluates protein-coding regions for variants that may explain an unexplained constitutional or heritable disorder or syndrome.
Medicare pays $4,780.00 for 81415 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
$4,780.00
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 81415 covers
Exome sequence analysis examines protein-coding portions of DNA to identify variants that may account for an unexplained constitutional or heritable disorder or syndrome. A clinical laboratory performs sequencing and analysis on DNA from the patient. Clinicians evaluating suspected inherited disorders may use exome testing when the findings do not point to a single specific gene; it provides broader sequencing than a targeted-gene test. Related family-member comparator sequencing is reported separately with 81416 when performed.
Report 81415 for the primary exome sequence analysis, not once per gene examined. Add 81416 for each comparator family member sequenced with the primary analysis. Medicare pays 81415 under the CLFS at one national amount, with no locality adjustment or office/facility difference. The 2026 national CLFS amount is $4,780.00, unchanged from 2020 through 2026. The test is paid through the CLFS rather than 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 81415
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 81415. 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 81415 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81415 on the lab fee schedule since 2020
81415 · CLFS 2026 Q4 (current)
$4,780.00
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.
81415 compared with similar tests
- 81416Exome sequencingEach comparator exome$12,000.00
- 81416 reports comparator sequencing of family members and is added to the primary exome analysis. 81415 reports the primary exome analysis.
- 81417Exome re-evaluationPreviously obtained sequence$320.00
- 81417 is for re-evaluating exome data obtained previously; 81415 is for the primary exome sequence analysis.
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81425 reports genome sequence analysis, which examines the genome. 81415 reports exome sequence analysis.
81415 billing questions
When should 81415 be reported instead of a targeted gene test?
Use 81415 for exome-wide sequence analysis in the evaluation of an unexplained constitutional or heritable disorder or syndrome. A test limited to a specific gene or defined panel is not exome analysis.
How is sequencing of relatives reported?
Report 81416 for comparator family-member sequencing as an add-on to the primary exome analysis reported with 81415.
Is 81415 reported once for every gene analyzed?
No. The exome analysis is not reported as separate units for each gene examined.
How does Medicare pay 81415?
Medicare pays the test through the CLFS at one national amount that applies across localities and in office and facility settings. The code is paid only through the CLFS.
How does 81415 differ from exome re-evaluation?
81415 represents the primary exome sequence analysis. Use 81417 for re-evaluation of exome sequence data obtained previously.
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
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