CPT code 81554: IPF gene test, 190-gene mRNA algorithm2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A 190-gene mRNA assay of transbronchial lung biopsy tissue that reports a categorical result during evaluation of suspected idiopathic pulmonary fibrosis.
Medicare pays $5,409.60 for 81554 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
$5,409.60
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
- −1.6%
- 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 81554 covers
This molecular laboratory assay analyzes mRNA expression across 190 genes associated with idiopathic pulmonary fibrosis (IPF). It uses transbronchial lung biopsy tissue and produces an algorithm-based categorical result, such as one indicating a high probability of usual interstitial pneumonia (UIP). The result is used in evaluating suspected IPF, and the laboratory reports it to the treating clinician.
Report 81554 for the 190-gene assay, not for biopsy acquisition or routine histopathologic examination of the tissue. Medicare pays the test only under the CLFS. The 2026 national amount is $5,409.60 and applies across states and localities, with no office-versus-facility adjustment. The code is excluded from the physician fee schedule by statute, so 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 81554
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 81554. 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 81554 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81554 on the lab fee schedule since 2021
81554 · CLFS 2026 Q4 (current)
$5,409.60
Down 1.6% from $5,500.00 in 2021
Every change on file
- Jan 1, 2026 · CLFS 2026 Q1$5,445.00 → $5,409.60 (−0.7%)
- Jan 1, 2025 · CLFS 2025 Q1$5,500.00 → $5,445.00 (−1.0%)
- Jan 1, 2024 · CLFS 2024 Q1$5,520.00 → $5,500.00 (−0.4%)
- Jan 1, 2023 · CLFS 2023 Q1$5,500.00 → $5,520.00 (+0.4%)
24 quarterly CLFS releases on file, first CLFS 2021 Q1. A code missing from a quarter wasn’t on that release.
81554 compared with similar tests
- 81538Lung survival assaySerum protein signature$2,871.00
- 81538 is a lung oncology assay. Use 81554 for the IPF-associated mRNA assay and its categorical UIP-related result.
- 31628Lung biopsySingle lobe$363.40–$540.69
- 31628 reports bronchoscopic transbronchial biopsy acquisition; 81554 reports molecular analysis of biopsy tissue.
- 88305Tissue pathology examLevel IV specimen$63.46–$92.44
- 88305 reports histopathologic examination of tissue. It is distinct from the 190-gene mRNA assay reported with 81554.
81554 billing questions
When should 81554 be selected instead of a lung oncology assay?
81554 is for the 190-gene mRNA assay associated with IPF and a categorical result related to UIP probability. A lung oncology assay addresses a cancer-related question instead.
Does 81554 include the transbronchial biopsy?
No. The assay analyzes biopsy tissue; bronchoscopic tissue acquisition is a separate service when performed and reportable.
Are the 190 genes reported as separate units?
No. The genes are components of the single assay, not separately counted services.
What documentation supports reporting 81554?
Documentation should identify the 190-gene mRNA assay on transbronchial biopsy tissue and its categorical result in the IPF evaluation.
How does Medicare pay 81554?
Medicare pays 81554 under the CLFS. Payment is nationally priced and is the same across localities and office or facility settings; the code 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
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