CPT code 81521: 70-Gene Breast Profile, 465 housekeeping genes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A 70-content-gene breast tumor mRNA profile that reports an algorithm-derived index related to distant-metastasis risk from fresh-frozen or FFPE tissue.
Medicare pays $3,873.00 for 81521 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 81521 covers
This assay analyzes breast tumor tissue with an mRNA expression profile covering 70 content genes and 465 housekeeping genes. The tested material may be fresh-frozen or formalin-fixed, paraffin-embedded tumor tissue. An algorithm converts the profile into an index related to risk of distant metastasis. Use the assay's gene profile, not indication alone, to distinguish it from other breast mRNA tests.
Report 81521 for the 70-content-gene profile with 465 housekeeping genes. Medicare pays 81521 under the CLFS. The 2026 national amount is $3,873.00, unchanged since 2020. One national amount applies in every state and locality, with no geographic adjustment or office/facility difference. The physician fee schedule excludes the test by statute, so payment is through the CLFS rather than 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 81521
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 81521. 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 81521 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81521 on the lab fee schedule since 2020
81521 · 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.
81521 compared with similar tests
- 81520Breast tumor profiling58-gene hybrid-capture assay$2,510.21
- 81521 is identified with 70 content genes and 465 housekeeping genes; 81520 is identified as a 58-gene breast mRNA profile. Select the code for the assay actually performed.
- 81523Breast mRNA profile70 genes plus 31 housekeeping genes$3,873.00
- 81523 is identified as a breast mRNA profile with 70 content and 31 genes. Choose between these codes according to the specific assay performed, not the shared 70-content-gene figure.
- 81518Breast mRNA assay11-gene recurrence profile$3,873.00
- 81518 identifies an 11-gene breast mRNA assay, rather than the 70-content-gene profile with 465 housekeeping genes reported with 81521.
- 81522Breast tumor profile12-gene recurrence score$3,873.00
- 81522 identifies a 12-gene breast mRNA assay. Use 81521 for the 70-content-gene profile with 465 housekeeping genes.
81521 billing questions
What tissue can be used for this profile?
The assay uses breast tumor tissue that is fresh-frozen or formalin-fixed and paraffin-embedded.
How is 81521 distinguished from 81520?
81521 identifies a profile with 70 content genes and 465 housekeeping genes; 81520 is identified as a 58-gene breast mRNA profile. Report the code matching the assay performed.
How does 81521 differ from 81523?
81523 is identified as a breast mRNA profile with 70 content and 31 genes. Select the code for the specific assay performed.
Can modifier 26 be used for physician interpretation?
81521 is paid only through the CLFS; the physician fee schedule excludes the test by statute.
What should the record identify?
Document the assay performed and tissue preparation format, including that the profile is the 70-content-gene test with 465 housekeeping genes.
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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