CPT code 81595: Heart transplant test, rejection-risk score2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Molecular gene-expression profiling of peripheral blood supports rejection-risk assessment in heart transplant recipients during post-transplant care.
Medicare pays $3,240.00 for 81595 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
$3,240.00
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 81595 covers
This test analyzes gene expression in a subfraction of peripheral blood from a heart transplant recipient. Real-time quantitative PCR evaluates 20 genes—11 content genes and 9 housekeeping genes—and an algorithm converts the results into a rejection-risk score. Heart transplant teams may order it as part of post-transplant monitoring; molecular laboratories perform the analysis and report the score.
Report 81595 for the completed heart transplant gene-expression test, not separately for each gene. Medicare pays it through the CLFS, with one national amount that applies across localities and has no office-versus-facility difference. The 2026 national CLFS amount is $3,240.00, unchanged since 2020. The test is paid only 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 81595
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 81595. 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 81595 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81595 on the lab fee schedule since 2020
81595 · CLFS 2026 Q4 (current)
$3,240.00
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.
81595 compared with similar tests
- 81558Kidney transplant test139-gene mRNA profile$3,240.00
- Choose 81595 for the heart transplant gene-expression risk score; 81558 is the kidney transplant molecular test.
- 81560Transplant assayCD154-positive memory cells$640.73
- 81560 reports a CD154-positive T-cell measurement for liver and bowel transplant assessment, not the heart transplant gene-expression profile and rejection-risk score.
81595 billing questions
When is 81595 appropriate?
Use it for the specified gene-expression profiling test that produces a rejection-risk score for a heart transplant recipient. It is not a general heart disease gene test.
Is the test reported per gene?
No. The code represents the completed profiling test and its resulting score, not separate reporting for each of the 20 genes.
How does 81595 differ from 81558?
81595 is the heart transplant gene-expression test. 81558 is a distinct molecular test for kidney transplant rejection assessment.
What specimen and method are involved?
The test uses a subfraction of peripheral blood and real-time quantitative PCR to assess gene expression.
Does Medicare payment vary by locality or setting?
No. The CLFS amount is national and applies across localities, with no office-versus-facility 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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