CPT code 81443: Inherited conditions panel, at least 15 genes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports genomic sequencing of a panel of at least 15 genes associated with severe inherited conditions, including cystic fibrosis and beta hemoglobinopathies.
Medicare pays $2,448.56 for 81443 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
$2,448.56
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 81443 covers
This panel analyzes genomic sequence across at least 15 genes associated with severe inherited conditions. The conditions may include cystic fibrosis, selected Ashkenazi Jewish-associated disorders such as Bloom syndrome or Tay-Sachs disease, beta hemoglobinopathies, phenylketonuria, and galactosemia. It supports evaluation across a multigene group of severe inherited disorders, rather than sequencing directed only to one named condition.
Medicare pays code 81443 through the Clinical Laboratory Fee Schedule (CLFS), with one national amount per code across all states and localities and no office-versus-facility payment difference. The 2026 national CLFS amount is $2,448.56, unchanged from 2020 through 2026. The test is paid only through the CLFS and 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 81443
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 81443. 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 81443 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81443 on the lab fee schedule since 2020
81443 · CLFS 2026 Q4 (current)
$2,448.56
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.
81443 compared with similar tests
- 81442Noonan panelMultigene sequence analysis$2,143.60
- Code 81442 is for Noonan spectrum disorders; 81443 is for a multigene panel associated with severe inherited conditions.
- 81430Hearing loss panelAt least 60 genes$1,625.00
- Code 81430 is for hearing-loss sequence analysis. Code 81443 addresses a panel of genes associated with severe inherited conditions.
- 81440Mitochondrial gene panelAt least 100 nuclear genes$3,324.00
- Code 81440 is for mitochondrial gene analysis; 81443 is for genomic sequencing of a severe inherited-condition panel of at least 15 genes.
- 81426Genome sequencingEach comparator genome$2,709.95
- Code 81426 is for genome sequence analysis. Code 81443 is defined by a panel of at least 15 genes associated with severe inherited conditions.
81443 billing questions
How many genes must the panel include?
The panel must include genomic sequencing of at least 15 genes.
What conditions can this panel address?
It is for severe inherited conditions, which can include cystic fibrosis, selected Ashkenazi Jewish-associated disorders, beta hemoglobinopathies, phenylketonuria, and galactosemia.
How does 81443 differ from 81442?
Code 81443 describes a panel for severe inherited conditions. Code 81442 is for Noonan spectrum disorders.
How does Medicare pay for 81443?
Medicare pays it through the CLFS at one national amount per code, without locality or office-versus-facility payment differences.
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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