CPT code 84163: PAPP-A test, serum assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Serum PAPP-A measurement supports first-trimester prenatal screening, particularly when interpreted with maternal factors, hCG, and fetal nuchal-translucency findings.
Medicare pays $15.05 for 84163 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
$15.05
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 84163 covers
This laboratory assay measures pregnancy-associated plasma protein-A (PAPP-A) in maternal serum. Obstetric and maternal-fetal medicine practices use the result in first-trimester prenatal screening for fetal aneuploidy, commonly alongside maternal serum hCG and ultrasound measurement of nuchal translucency. PAPP-A is a placental protein; the screening result is interpreted with gestational age and other patient-specific information rather than as a stand-alone diagnosis. Clinical laboratories perform the assay and report the serum result to the ordering clinician.
Report 84163 for the PAPP-A assay itself, not for a complete serum screening and risk-calculation service. When a first-trimester screening panel code accounts for the analytes and risk assessment, distinguish that service from an individually reported assay. Medicare pays one national CLFS amount per code in every locality, without geographic or office/facility adjustment. The 2026 national amount is $15.05, unchanged since 2020. The test is paid only 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 84163
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 84163. 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 84163 with status X (excluded by statute), so the test itself is paid only from the CLFS.
84163 on the lab fee schedule since 2020
84163 · CLFS 2026 Q4 (current)
$15.05
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.
84163 compared with similar tests
- 81508Prenatal Risk AssayTwo Serum Proteins$54.30
- Use 84163 for the individual PAPP-A assay. Use 81508 for the first-trimester serum screening service that includes PAPP-A, hCG, and risk assessment.
- 84702hCG testQuantitative level$15.05
- Code 84702 measures quantitative hCG, a separate analyte. Code 84163 measures PAPP-A in serum.
- 84144Progesterone testSerum concentration$20.86
- Code 84144 measures progesterone, not PAPP-A. Choose based on the ordered analyte.
84163 billing questions
Does 84163 include a first-trimester screening risk calculation?
No. It reports the PAPP-A assay; a complete screening service with risk assessment is represented by a different code.
How does 84163 differ from 81508?
84163 reports the PAPP-A assay alone. Code 81508 represents first-trimester maternal serum screening that includes PAPP-A, hCG, and risk assessment.
Can PAPP-A be reported with an hCG test?
PAPP-A and hCG are distinct analytes and may be part of the same first-trimester screening workup. Code 84163 reports only the PAPP-A assay.
What should the record support?
Document the order and serum PAPP-A result, along with the clinical screening context when applicable. The assay result alone is not a diagnosis of fetal aneuploidy.
How does Medicare pay for 84163?
Medicare pays the test through the CLFS at one national amount per code, with no locality or office/facility adjustment. 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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