CPT code 88261: Chromosome analysis, five-cell count2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Banding-based chromosome analysis is reported for a five-cell count and one karyotype when evaluating suspected chromosome abnormalities.
Medicare pays $264.34 for 88261 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
$264.34
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 88261 covers
This cytogenetic service examines chromosomes for genetic abnormalities using banding and reports a five-cell count with one karyotype. It may support evaluation of suspected chromosome abnormalities. Cytogenetics laboratories analyze submitted specimens; the code identifies the cell-count tier rather than a particular specimen type.
Report 88261 for the analysis represented by its five-cell count and one karyotype, not as a per-cell unit. Choose among chromosome-analysis codes according to the cell count and applicable specimen-specific code. Medicare pays this test only through the CLFS, not the physician fee schedule. The 2026 national CLFS payment amount is $264.34, unchanged since 2020; one national amount applies in every locality, without geographic or office-versus-facility adjustment.
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 88261
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 88261. 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 88261 with status X (excluded by statute), so the test itself is paid only from the CLFS.
88261 on the lab fee schedule since 2020
88261 · CLFS 2026 Q4 (current)
$264.34
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.
88261 compared with similar tests
- 88262Chromosome analysis15–20 cells, two karyotypes$125.49
- 88261 represents a five-cell count with one karyotype; 88262 is for a higher cell-count tier. Match the code to the analysis performed.
- 88263Chromosome analysis45 cells for mosaicism$150.29
- 88263 represents a 45-cell chromosome analysis, rather than the five-cell count reported with 88261.
- 88271DNA probeEach probe$21.42
- 88271 is cytogenetic DNA probe analysis. Use 88261 for banding-based chromosome analysis with a karyotype.
- 88269Amniotic karyotypeSix to 12 colonies$173.66
- 88269 is the specimen-specific chromosome-analysis code for amniotic material; 88261 identifies the cell-count tier.
88261 billing questions
When should 88261 be selected instead of 88262?
Use 88261 for the five-cell analysis with one karyotype. Code 88262 represents a higher cell-count tier, so select the code that matches the analysis performed.
Is 88261 billed per cell?
No. The five-cell count describes the analysis represented by the code; it is not a separate claim unit for each cell.
How does 88261 differ from chromosome probe testing?
88261 is a banding-based chromosome analysis with a karyotype. Code 88271 represents cytogenetic DNA probe analysis, a different testing approach.
Does Medicare pay 88261 through the physician fee schedule?
No. Medicare pays this test through the CLFS, with one national amount across localities and no office-versus-facility adjustment.
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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