CPT code 81528: Stool DNA test, DNA markers and hemoglobin2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A stool-based colorectal cancer screening assay analyzes DNA markers and hemoglobin and reports an algorithmic positive or negative result.
Medicare pays $508.87 for 81528 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
$508.87
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 81528 covers
This laboratory screening assay examines stool for DNA changes associated with colorectal cancer, including KRAS mutations and methylation markers, along with fecal hemoglobin. An algorithm combines the findings into a positive or negative result. It is ordered by clinicians as a noninvasive option for colorectal cancer screening; the laboratory performs the analysis on a stool specimen.
Report the integrated assay under 81528, not as separate tests for its individual markers or hemoglobin component. Medicare pays it only through the CLFS, at one national amount per code with no locality or office-versus-facility adjustment. The 2026 national CLFS amount is $508.87. The service is excluded from the physician fee schedule and has no separate physician interpretation payment under that 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 81528
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 81528. 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 81528 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81528 on the lab fee schedule since 2020
81528 · CLFS 2026 Q4 (current)
$508.87
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.
81528 compared with similar tests
- G0328FIT screeningOne to three simultaneous tests$18.05
- G0328 reports an immunochemical fecal occult blood test. Use 81528 for the integrated stool DNA-marker and hemoglobin assay.
- 81525Colon tumor profileTwelve-gene recurrence score$3,116.00
- 81525 is an oncology colon mRNA assay, whereas 81528 is a stool-based colorectal cancer screening test.
- G0121Screening colonoscopyNot high risk$335.22–$497.73
- G0121 describes a screening colonoscopy for an average-risk patient. 81528 describes laboratory analysis of a stool specimen.
81528 billing questions
How is 81528 different from a fecal immunochemical test?
81528 combines stool DNA-marker analysis with fecal hemoglobin and an algorithmic result. A fecal immunochemical test detects blood in stool rather than analyzing the DNA markers in this assay.
Are the DNA markers and hemoglobin billed separately?
No. Report the integrated assay as 81528; its marker analysis, hemoglobin measurement, and combined result are components of the test.
What result does the laboratory report?
The assay reports a combined positive or negative result, rather than separate results for each marker.
Does Medicare pay 81528 under the physician fee schedule?
No. Medicare pays the test through the CLFS. The national amount applies across localities and does not vary between office and facility settings.
Is 81528 the same as the colon tumor gene-expression assay?
No. 81528 is a stool-based screening assay; 81525 is an oncology colon mRNA assay, not this stool screening test.
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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