CPT code 81525: Colon tumor profile, twelve-gene recurrence score2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This assay profiles gene expression in colon-related cancer tissue and uses an algorithm to produce a recurrence score.
Medicare pays $3,116.00 for 81525 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
$3,116.00
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 81525 covers
81525 is a molecular gene-expression profile for colon-related cancer. The assay uses real-time RT-PCR to analyze 12 genes—seven content genes and five housekeeping genes—in formalin-fixed, paraffin-embedded tumor tissue. An algorithm converts the expression results into a recurrence score. The result is a single score based on the combined gene-expression profile, reported by the laboratory for the ordering clinician.
Report 81525 for the completed gene-expression profile; the genes are not separate services. Medicare pays the test through the CLFS at one national amount applied in every state and locality, with no office-versus-facility difference. The 2026 national CLFS amount is $3,116.00, unchanged since 2020. The physician fee schedule excludes the test by statute, so Medicare payment is 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 81525
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 81525. 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 81525 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81525 on the lab fee schedule since 2020
81525 · CLFS 2026 Q4 (current)
$3,116.00
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.
81525 compared with similar tests
- 81528Stool DNA testDNA markers and hemoglobin$508.87
- 81528 is for colorectal cancer screening. Use 81525 for gene-expression profiling of colon-related cancer tissue that produces a recurrence score.
- 81520Breast tumor profiling58-gene hybrid-capture assay$2,510.21
- 81520 is an oncology mRNA assay for breast cancer; 81525 is for colon-related cancer.
- 81540Tumor classifier92-gene mRNA assay$3,750.00
- 81540 is for a tumor of unknown origin. 81525 is specific to colon-related cancer and reports a recurrence score.
81525 billing questions
How is 81525 different from 81528?
81525 profiles gene expression in colon-related cancer tissue and reports a recurrence score. 81528 is for colorectal cancer screening.
What specimen is used for 81525?
The assay uses formalin-fixed, paraffin-embedded tumor tissue.
Are the 12 genes billed separately?
No. The assay reports a gene-expression profile and an algorithm-derived score under 81525; the individual genes are not separate services.
How does Medicare pay for 81525?
Medicare pays 81525 through the CLFS at one national amount across localities, without an office-versus-facility difference.
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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