CPT code 81434: Retinal gene panel, sequence analysis, 15 or more genes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A genomic sequencing panel for inherited retinal disorders, reported when clinicians investigate conditions such as retinitis pigmentosa, Leber congenital amaurosis, or cone-rod dystrophy.
Medicare pays $597.91 for 81434 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
$597.91
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 7 sections
What 81434 covers
This panel analyzes genomic sequences from at least 15 genes associated with hereditary retinal disorders, including ABCA4, EYS, RPE65, RPGR, and USH2A. It can help investigate inherited conditions such as retinitis pigmentosa, Leber congenital amaurosis, and cone-rod dystrophy. Ophthalmologists, retinal specialists, and medical geneticists may order the test when a patient’s clinical findings suggest an inherited retinal disease. A clinical laboratory performs and reports the genetic analysis.
Report 81434 for the qualifying retinal-disorder sequencing panel, rather than for a single-gene test or a panel directed at another condition. Medicare pays the test through the CLFS, with one national amount that applies across localities and in office and facility settings. The 2026 national CLFS amount is $597.91, the same amount applied from 2020 through 2025. The test is excluded from the physician fee schedule by statute and is paid only from the CLFS.
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 81434
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 81434. 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 81434 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81434 on the lab fee schedule since 2020
81434 · CLFS 2026 Q4 (current)
$597.91
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.
81434 compared with similar tests
- 81425Genome sequencingConstitutional or heritable disorders$5,031.20
- 81434 is a panel focused on inherited retinal disorders and sequences at least 15 genes. Code 81425 describes genome sequence analysis.
- 81426Genome sequencingEach comparator genome$2,709.95
- Use 81434 for the hereditary retinal disorder panel. Code 81426 describes genome sequence analysis rather than this condition-focused panel.
- 81427Genome reevaluationPreviously obtained sequence$2,337.65
- Code 81434 reports a hereditary retinal disorder sequencing panel; 81427 describes genome re-evaluation rather than the panel itself.
81434 billing questions
When is 81434 appropriate?
Use it for genomic sequence analysis of a panel of at least 15 genes associated with hereditary retinal disorders. It is relevant to evaluations for conditions such as retinitis pigmentosa, Leber congenital amaurosis, and cone-rod dystrophy.
How does this differ from genome sequencing codes 81425 and 81426?
Code 81434 identifies a panel focused on hereditary retinal disorders. Codes 81425 and 81426 describe genome sequence analysis rather than this retinal-disease-focused panel.
Can 81434 be reported for a single-gene test?
No. The code describes a genomic sequencing panel that includes at least 15 genes; a single-gene analysis does not meet that panel scope.
How does Medicare pay for 81434?
Medicare pays it through the CLFS at one national amount across localities, with no office-versus-facility difference. It is paid only from the CLFS.
What documentation supports reporting 81434?
Documentation should support a hereditary retinal disorder genomic sequencing panel that includes at least 15 genes and the clinical evaluation for an inherited retinal condition.
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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