CPT code 82043: Urine albumin, quantitative measurement2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures albumin concentration in urine, commonly to assess albuminuria during kidney disease evaluation and monitoring, including for patients with diabetes.
Medicare pays $5.78 for 82043 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
$5.78
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
- QW · CLIA-waived test
- $5.78
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 82043 covers
This laboratory test quantitatively measures albumin in a urine specimen. It is commonly ordered when clinicians assess kidney damage or monitor albuminuria, including for people with diabetes, chronic kidney disease, or hypertension. Testing is performed by clinical laboratories and may also be performed at a site holding a CLIA certificate of waiver using the CLIA-waived version. A urine albumin result is distinct from a urine albumin-to-creatinine ratio, which uses a urine creatinine measurement as well.
Report 82043 for the quantitative urine albumin measurement; report the quantitative assay rather than the semiquantitative urine test when the laboratory measures albumin quantitatively. CMS lists modifier QW for the CLIA-waived version performed by a site holding a CLIA certificate of waiver. Medicare pays this test only through the CLFS. The 2026 national CLFS amount is $5.78, unchanged since 2020; the same amount applies across localities, without an office or facility difference.
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 82043
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 82043. 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 82043 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 82043 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $5.78.
82043 on the lab fee schedule since 2020
82043 · CLFS 2026 Q4 (current)
$5.78
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.
82043 compared with similar tests
- 82044Urine albuminSemiquantitative$6.23
- 82043 reports a quantitative urine albumin measurement; 82044 is for a semiquantitative result.
- 82042Fluid albuminCSF or amniotic fluid$7.78
- 82043 is specific to urine. 82042 is used for quantitative albumin testing from another source.
- 82040Albumin assayBlood specimen$4.95
- 82043 measures urine albumin; 82040 measures serum albumin, a different specimen and test.
- 82570Urine creatinineUrine specimen$5.18
- 82570 measures urine creatinine, not albumin. It may be reported with 82043 when urine albumin-to-creatinine ratio testing is performed.
82043 billing questions
When should 82043 be used instead of 82044?
Use 82043 when the laboratory quantitatively measures urine albumin. Use 82044 for a semiquantitative urine albumin result.
Does 82043 include the urine albumin-to-creatinine ratio?
82043 represents the quantitative urine albumin measurement. When the ratio is calculated using urine creatinine, that measurement is commonly reported separately with 82570.
When is modifier QW relevant?
CMS lists QW for the CLIA-waived version. It is relevant when the test is performed by a site holding a CLIA certificate of waiver.
Does Medicare pay 82043 under the physician fee schedule?
No. Medicare pays 82043 through the CLFS, with one national amount that applies across localities and settings.
What should the documentation support?
The record should support the urine albumin test and its clinical purpose, such as evaluating or monitoring albuminuria. The reported code should reflect whether the laboratory performed a quantitative or semiquantitative measurement.
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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