CPT code 81426: Genome sequencing, each comparator genome2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Genome sequencing of each relative used for comparison in a diagnostic evaluation of an unexplained constitutional or heritable disorder, reported with proband sequencing.
Medicare pays $2,709.95 for 81426 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
$2,709.95
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 81426 covers
81426 represents sequencing a comparator genome, such as a parent’s or sibling’s, for comparison with the proband’s genome in evaluation of an unexplained constitutional or heritable disorder. This analysis looks for disease-associated genetic findings in the comparator and helps interpret the proband’s results. A clinical genetics team may include comparator sequencing in the diagnostic workup, and a laboratory performs the sequence analysis.
Report 81426 with 81425 for the proband’s genome analysis, using one unit for each comparator genome sequenced. Medicare pays the test only through the CLFS, with one national amount applying in every locality and no office-versus-facility adjustment. The 2026 national CLFS amount is $2,709.95, unchanged since 2020.
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 81426
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 81426. 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 81426 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81426 on the lab fee schedule since 2020
81426 · CLFS 2026 Q4 (current)
$2,709.95
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.
81426 compared with similar tests
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81425 reports genome analysis for the proband. 81426 reports each comparator genome and is reported with 81425.
- 81416Exome sequencingEach comparator exome$12,000.00
- 81416 is for each comparator exome in an exome-based evaluation; 81426 is for each comparator genome in a genome-based evaluation.
- 81427Genome reevaluationPreviously obtained sequence$2,337.65
- 81427 covers re-evaluation of genome data. 81426 covers sequencing an additional comparator genome.
81426 billing questions
When is 81426 reported instead of 81425?
81426 reports sequencing each comparator genome, such as a relative’s genome. 81425 reports the proband’s genome analysis and is the primary code.
How many units of 81426 should be reported?
Report one unit for each comparator genome sequenced. The number of units should match the comparator genomes analyzed.
Can 81426 be reported by itself?
It is an add-on code reported with 81425 for the proband’s genome analysis.
How does Medicare pay for 81426?
Medicare pays 81426 only through the CLFS. The national amount applies in every locality and does not vary by office or facility setting.
Is 81426 for reanalysis of previously sequenced genome data?
No. 81426 represents sequencing a comparator genome; 81427 is the genome re-evaluation code.
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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