CPT code 81430: Hearing loss panel, at least 60 genes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A multigene sequencing panel evaluates inherited causes of hearing loss, including nonsyndromic and syndromic conditions such as Usher syndrome.
Medicare pays $1,625.00 for 81430 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
$1,625.00
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 81430 covers
This molecular test sequences a broad set of genes associated with hearing loss, including genes such as GJB2, SLC26A4, and MYO7A. It may be ordered when inherited hearing loss is suspected, whether the presentation is isolated or part of a syndrome such as Usher or Pendred syndrome. Molecular diagnostic laboratories perform the analysis; clinicians including otolaryngologists and medical geneticists may order or use the results in evaluating a patient.
Report 81430 for the qualifying hearing-loss genomic sequencing panel, not separately for each gene analyzed. A distinct deletion/duplication analysis is represented by 81431 when that analysis is performed. Medicare pays this test only under the CLFS. The 2026 national CLFS amount is $1,625, unchanged since 2020; the same amount applies across localities, with no office or facility difference. The physician fee schedule does not separately pay this test.
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 81430
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 81430. 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 81430 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81430 on the lab fee schedule since 2020
81430 · CLFS 2026 Q4 (current)
$1,625.00
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.
81430 compared with similar tests
- 81431Hearing lossDuplication/deletion panel$679.57
- 81430 represents sequencing of a hearing-loss gene panel; 81431 represents deletion/duplication analysis. Choose according to the analysis actually performed.
- 81415Exome analysisInitial sequence analysis$4,780.00
- 81415 is for exome sequence analysis, a broader testing approach than the targeted hearing-loss gene panel represented by 81430.
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81425 represents genome sequence analysis rather than the targeted hearing-loss panel represented by 81430.
81430 billing questions
When is 81430 appropriate instead of 81431?
Use 81430 for the hearing-loss genomic sequencing panel. Code 81431 represents deletion/duplication analysis, a different type of testing.
Is 81430 reported per gene?
No. It represents the panel analysis, not a separate service for each gene included.
Does 81430 include deletion/duplication analysis?
81430 represents sequencing, while 81431 represents deletion/duplication analysis. Select the code that matches the analysis performed.
What should the test documentation identify?
Document the hearing-loss indication and the genomic sequencing panel performed. The record should support that the service was panel sequencing rather than deletion/duplication analysis alone.
How does Medicare pay 81430?
Medicare pays it through the CLFS at one national amount across localities, without an office or facility payment difference. The physician fee schedule does not separately pay the test.
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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