CPT code 81512: Prenatal screen, five-analyte maternal serum2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A maternal serum screening assay combines five biochemical analytes into a risk score for fetal congenital abnormalities.
Medicare pays $69.52 for 81512 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
$69.52
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 81512 covers
This prenatal screening assay measures AFP, unconjugated estriol (uE3), total hCG, hyperglycosylated hCG, and dimeric inhibin A in maternal serum. A laboratory combines the results using an algorithm to produce a risk score for fetal congenital abnormalities. Obstetric clinicians may order the test as part of prenatal screening; it estimates risk rather than establishing a diagnosis.
Report 81512 for the five-analyte assessment and its algorithm-derived risk score. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $69.52 and has remained unchanged since 2020. One amount applies across all states and localities, with no geographic or office-versus-facility adjustment. The code 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 81512
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 81512. 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 81512 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81512 on the lab fee schedule since 2020
81512 · CLFS 2026 Q4 (current)
$69.52
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.
81512 compared with similar tests
- 81511Prenatal screenFour-analyte risk score$153.50
- 81511 represents the four-analyte sibling assay; 81512 represents the five-analyte assessment.
- 81510Triple screenAFP, uE3, and hCG$55.54
- 81510 is a three-analyte fetal congenital abnormality screening assay; select 81512 for the five-analyte risk assessment.
- 81507Trisomy screeningTrisomies 21, 18, and 13$795.00
- 81507 screens for fetal aneuploidy and trisomy risk. 81512 is a five-analyte maternal serum screen for fetal congenital abnormalities.
81512 billing questions
When should 81512 be selected instead of a lower-count fetal screening code?
Use 81512 when the reported maternal serum algorithm combines five analytes into a risk score. The neighboring codes represent different analyte counts or assay groupings.
What does 81512 report?
It represents a five-analyte maternal serum assessment with an algorithm-derived risk score for fetal congenital abnormalities.
What specimen does this test use?
The assay uses maternal serum.
Is 81512 a diagnostic test for fetal abnormalities?
No. It provides a screening risk score; it does not itself establish a fetal diagnosis.
How does Medicare pay 81512?
Medicare pays it through the CLFS at one national amount, consistent across localities and settings. It is excluded from the physician fee schedule.
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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