CPT code 81596: HCV fibrosis test, six-assay serum algorithm2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This serum-based biochemical algorithm evaluates chronic hepatitis C by reporting calculated liver fibrosis and necroinflammatory activity scores.
Medicare pays $72.19 for 81596 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
$72.19
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 81596 covers
81596 represents a serum-based biochemical assessment for chronic hepatitis C. The laboratory measures ALT, alpha-2-macroglobulin, apolipoprotein A-I, total bilirubin, GGT, and haptoglobin, then applies an algorithm to generate scores for liver fibrosis and necroinflammatory activity. The results support assessment of chronic HCV infection. Clinical laboratories perform the testing; gastroenterology, hepatology, and infectious disease clinicians may order or review the results during evaluation of chronic infection.
Report one unit for the combined six-assay algorithm, rather than six units for its individual measurements. Medicare pays this test only through the CLFS. The 2026 national CLFS amount is $72.19, unchanged since 2020. One amount applies in every state and locality, with no geographic or office-versus-facility adjustment. The test is excluded from 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 81596
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 81596. 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 81596 with status X (excluded by statute), so the test itself is paid only from the CLFS.
81596 on the lab fee schedule since 2020
81596 · CLFS 2026 Q4 (current)
$72.19
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.
81596 compared with similar tests
- 87522HCV viral loadQuantitative RNA$42.84
- 87522 measures HCV RNA in the specimen. Code 81596 uses biochemical assays to produce fibrosis and necroinflammatory activity scores.
- 87902Hepatitis C genotypeNucleic acid analysis$257.45
- 87902 identifies HCV genotype. Code 81596 evaluates liver fibrosis and necroinflammatory activity through a six-assay algorithm.
- 81599Unlisted MAAAUnlisted assayNo national amount
- 81599 is an unlisted multianalyte assay code. Use 81596 when the service is the specifically described six-assay chronic HCV algorithm.
81596 billing questions
When should this code be chosen instead of an HCV RNA test?
Use 81596 for the six-assay algorithm that reports fibrosis and necroinflammatory activity scores. HCV RNA testing measures viral nucleic acid and answers a different clinical question.
Is this reported as six units because it includes six assays?
No. The six measurements form one combined algorithmic test; report one unit for the test.
Does this code report HCV genotype testing?
No. It reports calculated liver fibrosis and necroinflammatory activity scores, not viral genotype.
How does Medicare pay for 81596?
Medicare pays it through the CLFS at one national amount applicable in every locality, with no office-versus-facility difference. It 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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