CPT code 81519: Breast gene assay, 21-gene recurrence score2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This breast cancer assay profiles 21 genes by real-time RT-PCR in preserved tissue and reports an algorithm-derived recurrence score.
Medicare pays $3,873.00 for 81519 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 81519 covers
This breast cancer gene-expression assay measures 21 genes in formalin-fixed, paraffin-embedded tissue using real-time RT-PCR. The laboratory applies an algorithm to the expression results and reports a recurrence score. Molecular laboratories perform the analysis on preserved tissue. The service is an mRNA-based expression profile.
Report 81519 for the 21-gene profiling assay; the code identifies the profile that produces the score. Medicare pays it only under the Clinical Laboratory Fee Schedule (CLFS), at one national amount per code in every state and locality, with no geographic or office/facility adjustment. The 2026 national CLFS amount is $3,873.00, unchanged since 2020. The test 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 81519
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 81519. 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 81519 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81519 on the lab fee schedule since 2020
81519 · 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.
81519 compared with similar tests
- 81518Breast mRNA assay11-gene recurrence profile$3,873.00
- 81519 identifies a 21-gene assay that reports a recurrence score; 81518 is the breast mRNA profiling code identified by an 11-gene assay.
- 81520Breast tumor profiling58-gene hybrid-capture assay$2,510.21
- 81519 identifies the 21-gene assay, while 81520 identifies a breast mRNA assay with 58 genes.
- 8152170-Gene Breast Profile465 housekeeping genes$3,873.00
- 81519 identifies the 21-gene assay, while 81521 identifies a breast mRNA assay with 70 genes.
81519 billing questions
When is 81519 appropriate instead of another breast gene-expression code?
Use 81519 for the 21-gene real-time RT-PCR assay that reports a recurrence score. Other breast profiling codes identify assays with different gene counts.
Does the 21-gene count mean 21 units?
The 21-gene count describes the assay's content, not a count of separately reported assays. Code 81519 identifies the profiling assay and its recurrence score.
What tissue is tested?
The assay analyzes breast tissue preserved as formalin-fixed, paraffin-embedded material.
Should modifier 26 be reported?
The test is paid only under the CLFS, not the physician fee schedule. Modifier 26 does not create separate physician-fee-schedule payment for 81519.
How does Medicare set payment for 81519?
Medicare uses one national CLFS amount across states and localities, with no geographic or office/facility adjustment.
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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