CPT code 81551: Prostate assay, three-gene methylation2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This prostate tumor tissue assay profiles methylation in three genes by real-time PCR and estimates the likelihood of cancer detection on repeat biopsy.
Medicare pays $2,030.00 for 81551 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
$2,030.00
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 7 sections
What 81551 covers
This molecular laboratory test analyzes prostate tumor tissue with real-time PCR, profiling methylation in three genes. An algorithm uses the results to estimate the likelihood of finding prostate cancer on repeat biopsy. The assay may be considered after an earlier prostate biopsy when repeat-biopsy assessment is part of clinical decision-making. A clinical laboratory performs and reports the molecular analysis using formalin-fixed, paraffin-embedded tissue.
Report 81551 for the three-gene methylation profile. Medicare pays the test through the CLFS at one national amount in every state and locality, without geographic adjustment or an office-versus-facility payment difference. The 2026 national CLFS amount is $2,030.00, unchanged since 2020. The test is paid through the CLFS, not 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 81551
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 81551. 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 81551 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81551 on the lab fee schedule since 2020
81551 · CLFS 2026 Q4 (current)
$2,030.00
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.
81551 compared with similar tests
- 81539Prostate risk scoreFour-protein probability score$760.00
- 81551 describes three-gene methylation profiling of prostate tumor tissue. Code 81539 describes a prostate oncology probability score assay.
- 81541Prostate profile46-gene mortality score$3,873.00
- 81551 profiles methylation in three genes; 81541 describes a prostate mRNA assay involving 46 genes.
- 81542Prostate genomic test22-gene metastasis risk profile$3,873.00
- 81551 profiles methylation in three genes; 81542 describes a prostate mRNA assay involving 22 genes.
81551 billing questions
What does 81551 analyze?
It profiles methylation in three genes in prostate tumor tissue by real-time PCR. An algorithm estimates the likelihood of prostate cancer detection on repeat biopsy.
What specimen is used for 81551?
The test uses formalin-fixed, paraffin-embedded prostate tumor tissue.
How does 81551 differ from prostate mRNA assays?
81551 profiles methylation in three genes. Codes 81541 and 81542 describe prostate mRNA assays.
How does 81551 differ from 81539?
81551 describes a three-gene prostate tumor methylation profile. Code 81539 describes a prostate oncology probability score assay.
How does Medicare pay for 81551?
Medicare pays 81551 through the CLFS using one national amount across localities, with no office-versus-facility payment 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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