CPT code 84202: Red-cell protoporphyrin, quantitative assay2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Quantitative red-cell protoporphyrin testing measures a marker of heme production, commonly ordered when evaluating lead exposure or disorders affecting hemoglobin synthesis.
Medicare pays $14.35 for 84202 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
$14.35
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 84202 covers
This assay quantifies protoporphyrin in red blood cells from a blood specimen. Clinicians may order it when investigating lead exposure or impaired heme production, including iron deficiency. The result is interpreted alongside the clinical picture and other laboratory findings; it is not a direct measurement of blood lead. Clinical laboratories perform and report the assay for clinicians evaluating these conditions, including in primary care and occupational health settings.
Report 84202 for quantitative red-cell protoporphyrin testing; 84203 is the qualitative sibling test. Medicare pays the test through the CLFS at one national amount in every locality, with no geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $14.35, unchanged since 2020. The physician fee schedule classifies the test as excluded by statute, and Medicare pays it 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 84202
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 84202. 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 84202 with status X (excluded by statute), so the test itself is paid only from the CLFS.
84202 on the lab fee schedule since 2020
84202 · CLFS 2026 Q4 (current)
$14.35
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.
84202 compared with similar tests
- 84203RBC protoporphyrinScreening test$9.74
- Choose 84202 when the red-cell protoporphyrin result is quantitative; 84203 represents qualitative testing.
- 83655Lead testBlood lead level$12.11
- Code 83655 measures lead in blood. Code 84202 measures red-cell protoporphyrin, a related but different laboratory finding.
- 85025Complete CBCAutomated differential$7.77
- Code 85025 reports a CBC with automated differential, not a protoporphyrin assay. The tests may be ordered together for an anemia evaluation.
84202 billing questions
When should 84202 be used instead of 84203?
Use 84202 for quantitative red-cell protoporphyrin testing. Code 84203 is the qualitative sibling test.
Is this a blood lead test?
No. It measures red-cell protoporphyrin, which may support evaluation of lead exposure; 83655 measures blood lead.
Can 84202 be reported with a blood lead test?
They measure different analytes and may be reported together when both are ordered for the same lead-exposure evaluation.
Is modifier 26 appropriate?
No. Medicare pays 84202 only through the CLFS, not as a separately payable physician-fee-schedule interpretation.
How does Medicare pay 84202?
Medicare pays one national CLFS amount for the code, regardless of locality or office-versus-facility setting.
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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