CPT code 81427: Genome reevaluation, previously obtained sequence2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reassesses a previously obtained genome sequence when updated knowledge or a different clinical question may clarify an unexplained constitutional or heritable condition.
Medicare pays $2,337.65 for 81427 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
$2,337.65
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 81427 covers
This service reevaluates previously obtained genome sequence data rather than generating an initial genome sequence analysis. Reevaluation may be prompted by updated genetic knowledge or by a different clinical question, including an unrelated condition or syndrome. The code is associated with evaluating unexplained constitutional or heritable disorders. The distinction is whether the genome sequence already exists and is being reconsidered, not whether a new genome sequence is being generated.
Report 81427 for reevaluation of a previously obtained genome sequence, not for the initial sequence analysis. Medicare pays it under the CLFS at one national amount, with no locality, GPCI, or office-versus-facility adjustment. The 2026 national CLFS amount is $2,337.65, unchanged from 2020 through 2026. Medicare pays the test only through the CLFS; it 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 81427
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 81427. 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 81427 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81427 on the lab fee schedule since 2020
81427 · CLFS 2026 Q4 (current)
$2,337.65
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.
81427 compared with similar tests
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81425 is for genome sequence analysis. Use 81427 when the genome sequence was obtained previously and is being reevaluated.
- 81417Exome re-evaluationPreviously obtained sequence$320.00
- Both codes address reevaluation of existing sequencing data, but 81417 applies to exome sequence and 81427 to genome sequence.
- 81415Exome analysisInitial sequence analysis$4,780.00
- 81415 is for exome sequence analysis; 81427 is for reevaluation of a previously obtained genome sequence.
81427 billing questions
When should 81427 be reported instead of 81425?
Use 81427 for reevaluation of genome sequence data obtained previously. Code 81425 is for genome sequence analysis, rather than reevaluation of an existing sequence.
How does 81427 differ from 81417?
Both describe reevaluation, but 81427 concerns a previously obtained genome sequence; 81417 concerns a previously obtained exome sequence.
Does this code report a new genome sequencing analysis?
No. Report 81427 for reevaluation of an existing genome sequence; initial genome sequence analysis is represented by a different code.
Is modifier 26 used for a physician interpretation?
No. Medicare pays 81427 only through the CLFS, and the code is excluded from the physician fee schedule.
Does Medicare pay different amounts by locality or setting?
No. The CLFS amount is national and applies across localities, without an office-versus-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
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