CPT code 81542: Prostate genomic test, 22-gene metastasis risk profile2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This assay analyzes 22 mRNA genes in prostate tumor tissue and reports an algorithm-derived metastasis risk score.
Medicare pays $3,873.00 for 81542 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 2021
- 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 81542 covers
The service profiles expression across 22 mRNA genes in prostate tumor tissue using microarray analysis. The tissue is formalin-fixed and paraffin-embedded. An algorithm converts the gene-expression profile into a metastasis risk score. This is a defined 22-gene prostate tumor profile, distinct from prostate oncology assays with other gene counts or assay designs.
Report 81542 for this 22-gene mRNA profile. Medicare pays the service only through the CLFS, which sets one national amount per code for all states and localities, without geographic adjustment or an office/facility difference. The 2026 national CLFS amount is $3,873.00, unchanged since 2021. The test is excluded from the physician fee schedule, so Medicare payment for 81542 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 81542
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 81542. 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 81542 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81542 on the lab fee schedule since 2020
81542 · CLFS 2026 Q4 (current)
$3,873.00
Unchanged since Jan 1, 2021
Every change on file
- Jan 1, 2021 · CLFS 2021 Q1MAC-priced → $3,873.00
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
81542 compared with similar tests
- 81541Prostate profile46-gene mortality score$3,873.00
- Use 81542 for the 22-gene mRNA profile with a metastasis risk score; 81541 identifies a 46-gene prostate mRNA profile.
- 81539Prostate risk scoreFour-protein probability score$760.00
- 81539 identifies a different prostate oncology score assay. Report 81542 when the 22-gene mRNA profile was performed.
- 81551Prostate assayThree-gene methylation$2,030.00
- 81551 identifies a three-gene prostate oncology assay; 81542 identifies a 22-gene mRNA profile with a metastasis risk score.
81542 billing questions
What specimen is analyzed for 81542?
The assay analyzes prostate tumor tissue that is formalin-fixed and paraffin-embedded.
What result does the assay report?
An algorithm reports a metastasis risk score from the 22-gene mRNA expression profile.
How does 81542 differ from 81541?
81542 identifies a 22-gene prostate mRNA profile, while 81541 identifies a 46-gene prostate mRNA profile.
How does 81542 differ from 81539?
81539 identifies a different prostate oncology score assay. Select the code for the assay actually performed rather than by the shared prostate cancer indication.
How does Medicare pay 81542?
Medicare pays 81542 through the CLFS at one national amount across states and localities, without an office or facility difference. The test is excluded from the physician fee schedule.
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
Fee sheets · Coming soon
Put 81542 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist