CPT code 81518: Breast mRNA assay, 11-gene recurrence profile2026 Medicare lab fee · Clinical Laboratory Fee Schedule
An 11-gene breast tumor mRNA profile uses formalin-fixed, paraffin-embedded tissue to estimate metastatic recurrence risk and potential benefit from extended endocrine therapy.
Medicare pays $3,873.00 for 81518 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
$3,873.00
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 81518 covers
This molecular oncology assay analyzes expression of 11 genes in breast tumor tissue by real-time RT-PCR using formalin-fixed, paraffin-embedded material. Seven genes contribute to the reported profile, alongside four housekeeping genes. An algorithm reports metastatic recurrence risk and the likelihood of benefit from extended endocrine therapy. The reported measures are generated from that expression profile.
Medicare pays 81518 through the CLFS, which sets one national amount for all localities. The 2026 national CLFS amount is $3,873.00, unchanged from 2020 through 2026. Payment has no geographic adjustment or office/facility difference. The test is excluded from the physician fee schedule by statute and is paid only through 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 81518
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 81518. 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 81518 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81518 on the lab fee schedule since 2020
81518 · CLFS 2026 Q4 (current)
$3,873.00
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.
81518 compared with similar tests
- 81522Breast tumor profile12-gene recurrence score$3,873.00
- 81518 is the 11-gene profile; 81522 identifies a 12-gene breast tumor mRNA profile. Use the code corresponding to the assay performed.
- 81520Breast tumor profiling58-gene hybrid-capture assay$2,510.21
- 81520 identifies a 58-gene breast tumor mRNA assay, rather than the 11-gene profile reported with 81518.
- 8152170-Gene Breast Profile465 housekeeping genes$3,873.00
- 81521 identifies a 70-gene breast tumor mRNA assay, distinct from the 11-gene profile represented by 81518.
81518 billing questions
What specimen is analyzed?
The assay uses formalin-fixed, paraffin-embedded breast tumor tissue.
What does the assay report?
Its algorithm reports metastatic recurrence risk and the likelihood of benefit from extended endocrine therapy.
What does the 11-gene profile include?
It analyzes 11 genes: seven genes contributing to the reported profile and four housekeeping genes.
How is 81518 distinguished from 81522?
81518 identifies an 11-gene breast tumor mRNA profile, while 81522 identifies a 12-gene profile. Select the code that matches the assay performed.
How does Medicare pay for 81518?
Medicare pays 81518 through the CLFS, with one national amount that applies in every locality and in office and facility settings. The test is excluded from the physician fee schedule by statute.
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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