CPT code 81523: Breast mRNA profile, 70 genes plus 31 housekeeping genes2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Next-generation sequencing of breast tumor mRNA measures a 70-gene profile and reports an index related to distant-metastasis risk.
Medicare pays $3,873.00 for 81523 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 2022
- 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 81523 covers
This test uses next-generation sequencing to profile mRNA from formalin-fixed, paraffin-embedded breast tumor tissue. It evaluates 70 content genes alongside 31 housekeeping genes and reports an algorithm-derived index related to the risk of distant metastasis. A molecular laboratory performs the assay and reports the profile.
Report 81523 for the completed profile, rather than separately for individual genes. The CLFS pays one nationally priced amount per code. Medicare pays the test only through the Clinical Laboratory Fee Schedule. The 2026 national CLFS amount is $3,873.00, unchanged from 2022 through 2025. That single amount applies across states and localities, with no geographic or office-versus-facility adjustment. The physician fee schedule excludes this test 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 81523
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 81523. 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 81523 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81523 on the lab fee schedule since 2022
81523 · CLFS 2026 Q4 (current)
$3,873.00
Unchanged since Jan 1, 2022
20 quarterly CLFS releases on file, first CLFS 2022 Q1. A code missing from a quarter wasn’t on that release.
81523 compared with similar tests
- 8152170-Gene Breast Profile465 housekeeping genes$3,873.00
- Both describe 70-gene breast mRNA profiling. Choose 81523 for the next-generation sequencing profile with 31 housekeeping genes.
- 81520Breast tumor profiling58-gene hybrid-capture assay$2,510.21
- This is a 58-gene breast mRNA profile, rather than the 70-content-gene, 31-housekeeping-gene NGS profile reported with 81523.
- 81518Breast mRNA assay11-gene recurrence profile$3,873.00
- This breast mRNA profile is identified by an 11-gene panel, not the 70-content-gene NGS profile represented by 81523.
81523 billing questions
When should 81523 be selected instead of 81521?
Use 81523 for the breast mRNA profile performed by next-generation sequencing with 70 content genes and 31 housekeeping genes. The 81521 code identifies a different 70-gene breast profile.
What specimen is used for 81523?
The assay uses formalin-fixed, paraffin-embedded breast tumor tissue.
Are the genes reported as separate units?
No. The code represents the completed gene-expression profile and its algorithm-derived index, not separate charges for each gene.
Does Medicare pay 81523 under the physician fee schedule?
No. Medicare pays this test through the CLFS only; it is excluded from the physician fee schedule by statute.
Does the CLFS amount vary by locality or setting?
No. Medicare uses one national amount for this code across localities, without a geographic or office-versus-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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