CPT code 81520: Breast tumor profiling, 58-gene hybrid-capture assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A laboratory profile of 58 genes in formalin-fixed breast tumor tissue uses hybrid capture and reports an algorithm-derived recurrence-risk score.
Medicare pays $2,510.21 for 81520 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
$2,510.21
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 81520 covers
81520 identifies laboratory analysis of breast tumor tissue using hybrid capture to profile 58 genes. The assay uses formalin-fixed, paraffin-embedded tissue, and an algorithm reports the findings as a recurrence-risk score. This 58-gene hybrid-capture profile distinguishes the assay from other breast oncology gene-profile codes. A laboratory performs the assay and reports the result to the ordering clinician.
Report 81520 for this assay. Medicare pays it only through the Clinical Laboratory Fee Schedule (CLFS), using one national amount in every state and locality, without geographic (GPCI) adjustment or an office/facility payment difference. The 2026 national CLFS amount is $2,510.21, unchanged since 2020. The test 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 81520
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 81520. 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 81520 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81520 on the lab fee schedule since 2020
81520 · CLFS 2026 Q4 (current)
$2,510.21
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.
81520 compared with similar tests
- 81518Breast mRNA assay11-gene recurrence profile$3,873.00
- 81518 is associated with an 11-gene breast profile; 81520 identifies the 58-gene hybrid-capture profile.
- 8152170-Gene Breast Profile465 housekeeping genes$3,873.00
- 81521 is associated with a 70-gene breast profile; 81520 identifies the 58-gene hybrid-capture profile.
- 81522Breast tumor profile12-gene recurrence score$3,873.00
- 81522 is the 12-gene breast mRNA sibling. The profile performed determines whether 81522 or 81520 applies.
81520 billing questions
What specimen does 81520 analyze?
The assay profiles breast tumor tissue preserved as formalin-fixed, paraffin-embedded material.
How does 81520 differ from 81521?
81520 is the 58-gene hybrid-capture profile; 81521 is associated with a 70-gene breast profile. Select the code that matches the assay performed.
How many genes does 81520 profile?
The profile covers 58 genes.
What should the laboratory documentation identify?
Documentation should identify the 58-gene hybrid-capture breast tumor profile, the formalin-fixed, paraffin-embedded tissue, and the recurrence-risk score.
How does Medicare pay for 81520?
Medicare pays 81520 through the CLFS using one national amount that applies across localities and in office and facility settings.
Is 81520 paid under the physician fee schedule?
No. The test is excluded from the physician fee schedule by statute and is paid only through the CLFS.
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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