CPT code 81425: Genome sequencing, constitutional or heritable disorders2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Genome sequence analysis identifies genes associated with disease when evaluating an unexplained constitutional or heritable disorder or syndrome.
Medicare pays $5,031.20 for 81425 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
$5,031.20
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 81425 covers
This laboratory test analyzes genome sequence to identify genes associated with disease in an unexplained constitutional or heritable disorder or syndrome. It concerns genome sequence analysis, rather than exome sequence analysis, which is identified by 81415. Genome re-evaluation is identified separately by 81427, so 81425 describes sequence analysis rather than re-evaluation of previously obtained data. The clinical focus is a constitutional or heritable disorder or syndrome that remains unexplained.
Report 81425 for genome sequence analysis, not later genome re-evaluation, which is identified by 81427. Medicare pays the test only through the CLFS. The 2026 national amount is $5,031.20, unchanged since 2020. One amount applies in every state and locality, with no geographic adjustment or office/facility difference. The code is excluded from the physician fee schedule by statute.
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 81425
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 81425. 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 81425 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81425 on the lab fee schedule since 2020
81425 · CLFS 2026 Q4 (current)
$5,031.20
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.
81425 compared with similar tests
81425 billing questions
When should 81425 be chosen instead of 81415?
Use 81425 for genome sequence analysis. Code 81415 identifies exome sequence analysis, a different sequencing scope.
When is 81427 used instead of 81425?
81427 identifies genome re-evaluation. Code 81425 identifies genome sequence analysis.
Is a physician interpretation billed with 81425?
Medicare pays 81425 only through the CLFS; the code is excluded from the physician fee schedule by statute.
How does Medicare price 81425?
Medicare uses one national CLFS amount across states and localities, without a geographic or office/facility adjustment.
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
Fee sheets · Coming soon
Put 81425 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist