CPT code 81539: Prostate risk score, four-protein probability score2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A serum or plasma protein assay generates a probability score for high-grade prostate cancer during evaluation of men with elevated PSA.
Medicare pays $760.00 for 81539 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
$760.00
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 81539 covers
This assay measures four prostate cancer-associated proteins in serum or plasma: total PSA, free PSA, intact PSA, and human kallikrein-2. An algorithm combines the results into a probability score for high-grade prostate cancer. Urologists may order it when evaluating a man with an elevated PSA and considering whether a prostate biopsy is appropriate. The score supports risk assessment; it is not itself a cancer diagnosis.
Report one service for the completed assay and score, not separate units for the individual proteins. Medicare pays 81539 through the CLFS. The 2026 national CLFS amount is $760.00, unchanged from 2020 through 2026. The same amount applies in every state and locality, with no office-versus-facility difference. The test is paid 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 81539
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 81539. 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 81539 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81539 on the lab fee schedule since 2020
81539 · CLFS 2026 Q4 (current)
$760.00
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.
81539 compared with similar tests
- 84153Total PSA$18.39
- 84153 reports a total PSA measurement. 81539 combines four protein results algorithmically to produce a probability score for high-grade prostate cancer.
- 81541Prostate profile46-gene mortality score$3,873.00
- 81541 is a prostate mRNA assay. 81539 measures proteins in serum or plasma and reports an algorithmic probability score.
- 81542Prostate genomic test22-gene metastasis risk profile$3,873.00
- 81542 is another prostate mRNA assay, not the four-protein test represented by 81539.
- 81551Prostate assayThree-gene methylation$2,030.00
- 81551 is a prostate three-gene assay; 81539 uses four protein measurements to generate a probability score.
81539 billing questions
When is 81539 appropriate instead of a PSA test?
Use 81539 for the four-protein assay and algorithmic probability score used to assess the likelihood of high-grade prostate cancer. A PSA test such as 84153 reports a PSA measurement, not this risk score.
Should the four proteins be billed as separate units?
No. Report the completed assay and resulting score as one service; the four protein measurements are components of the test.
Does 81539 describe a biopsy or a cancer diagnosis?
No. It describes a laboratory-based probability score used in prostate cancer risk assessment. A biopsy, when performed, is a separate service.
How does Medicare pay for 81539?
Medicare pays the test under the CLFS at one national amount per code, with the same payment across localities and office or facility settings.
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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