CPT code 81417: Exome re-evaluation, previously obtained sequence2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports reassessment of previously obtained exome sequence data when updated genetic knowledge or a newly considered condition may change its interpretation.
Medicare pays $320.00 for 81417 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
$320.00
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 81417 covers
This laboratory service revisits the interpretation of exome sequence data generated earlier, rather than producing an initial exome analysis. Re-evaluation may be prompted by updated genetic knowledge or consideration of another unexplained constitutional or heritable condition. The service concerns existing exome data and may provide a new interpretation relevant to the clinical question.
Report 81417 for the re-evaluation, not the initial exome sequence analysis. Medicare pays the test through the CLFS at one nationally set amount across states and localities, without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $320.00, unchanged since 2020. The test is paid only through the CLFS and 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 81417
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 81417. 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 81417 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81417 on the lab fee schedule since 2020
81417 · CLFS 2026 Q4 (current)
$320.00
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.
81417 compared with similar tests
- 81415Exome analysisInitial sequence analysis$4,780.00
- 81415 is for initial exome sequence analysis. Use 81417 when previously obtained exome sequence data are being reassessed.
- 81416Exome sequencingEach comparator exome$12,000.00
- 81416 concerns comparator exome sequence data in an exome analysis; 81417 is for re-evaluating previously obtained exome data.
- 81427Genome reevaluationPreviously obtained sequence$2,337.65
- 81427 re-evaluates previously obtained genome sequence data. Code 81417 applies when the prior sequence data are exome data.
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81425 describes initial genome sequence analysis, not re-evaluation of prior exome sequence data.
81417 billing questions
When should 81417 be reported instead of 81415?
Use 81417 to re-evaluate previously obtained exome sequence data. Code 81415 describes initial exome sequence analysis.
How does 81416 differ from 81417?
Code 81416 concerns comparator exome sequence data in an exome analysis. Code 81417 re-evaluates previously obtained exome sequence data.
What distinguishes 81417 from 81427?
Code 81417 re-evaluates exome sequence data; 81427 re-evaluates genome sequence data.
Does Medicare pay 81417 under the physician fee schedule?
No. Medicare pays the test through the CLFS, at one national amount across localities and without an office-versus-facility 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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