Medicare Clinical Laboratory Fee Schedule (CLFS) 2020One national amount for every lab test
What Medicare pays for each clinical lab test in 2020, from CMS’s quarterly Clinical Laboratory Fee Schedule file: the most-billed tests, every code with its amount, and what changed this quarter.
On this page 6 sections
This is the lab fee schedule as of CLFS 2020 Q4, the last 2020 release. Code pages show today’s amounts; see the current lab fee schedule.
How Medicare pays lab tests
Clinical lab tests aren’t built from relative value units like physician services. CMS publishes one Clinical Laboratory Fee Schedule amount per test, the most Medicare pays for it anywhere in the country, and updates the file every quarter.
No locality or setting split
There’s no geographic (GPCI) adjustment and no office or facility rate: a test pays the same amount in every state, whoever performs it.
The lesser of charge and amount
Medicare pays the lower of the lab’s charge and the CLFS amount. Patients usually owe no Part B deductible or coinsurance for covered lab tests.
Quarterly releases
Amounts are reset each January. New tests join during the year, many of them proprietary laboratory analyses (PLA codes ending in U).
Contractor-priced tests
Codes with indicator L have no national amount. Each Medicare Administrative Contractor (MAC) prices them for its jurisdiction.
Most-billed lab tests
The 25 lab tests Medicare paid most often in 2024, with their 2020 national amount. Select a code for its amount history and billing rules.
| Test | National amount | 2024 services |
|---|---|---|
| 36415VenipunctureRoutine venous sample | $3.00 | 40.3M |
| 80053Metabolic panelFourteen blood chemistry tests | $10.56 | 27.2M |
| 85025Complete CBCAutomated differential | $7.77 | 26.2M |
| 80061Lipid panelCholesterol and triglycerides | $13.39 | 17.3M |
| 83036A1c testLaboratory assay | $9.71 | 14.6M |
| 84443TSH testThyroid-stimulating hormone | $16.80 | 13.9M |
| 87798Infectious agent testAmplified probe, each organism | $35.09 | 12.7M |
| 82306Vitamin D test25-hydroxy level | $29.60 | 6.4M |
| 81001UrinalysisAutomated with microscopy | $3.17 | 6.4M |
| 81003UrinalysisAutomated, without microscopy | $2.25 | 5.7M |
| 82570Urine creatinineUrine specimen | $5.18 | 5.5M |
| 84439Free T4Unbound thyroxine | $9.02 | 5.5M |
| 80048Basic metabolic panelTotal calcium | $8.46 | 5.1M |
| 82607Vitamin B12Level assay | $15.08 | 4.7M |
| 82043Urine albuminQuantitative measurement | $5.78 | 4.5M |
| 87086Urine cultureQuantitative colony count | $8.07 | 4.4M |
| 83540Iron assaySerum iron concentration | $6.47 | 3.6M |
| 83735Magnesium | $6.70 | 3.5M |
| 82728FerritinBlood ferritin level | $13.63 | 3.5M |
| 85027Complete CBCWithout automated differential | $6.47 | 3.3M |
| 84153Total PSA | $18.39 | 3.3M |
| 85610Prothrombin timeRoutine coagulation test | $4.29 | 3.3M |
| 87481Candida DNA testAmplified probe | $35.09 | 2.9M |
| 83550Iron bindingBinding capacity | $8.74 | 2.9M |
| 87186Susceptibility testMicrodilution or agar dilution | $8.65 | 2.7M |
Ranked by 2024 Medicare Part B services, office and facility combined, among tests with a national amount. Every code by volume
Find any lab test
Every lab code on CLFS 2020 Q4: CPT lab codes first, then multianalyte (M), proprietary (U) and HCPCS codes.
- 36415VenipunctureRoutine venous sample$3.00
- 78267Urea breath testCarbon-14 sample acquisition$11.06
- 78268Urea breath testC-14 analysis$94.41
- 80047Basic metabolic panelIonized calcium$13.73
- 80048Basic metabolic panelTotal calcium$8.46
- 80051Electrolyte panelFour blood electrolytes$7.01
- 80053Metabolic panelFourteen blood chemistry tests$10.56
- 80055Obstetric panelWithout HIV testing$47.81
- 80061Lipid panelCholesterol and triglycerides$13.39
- 80069Renal panelKidney-focused chemistry panel$8.68
- 80074Hepatitis panelFour viral markers$47.63
- 80076Liver panelSeven liver chemistry tests$8.17
- 80081Obstetric panelIncludes HIV testing$74.86
- 80145Adalimumab assayDrug concentration$38.57
- 80150Amikacin levelTherapeutic drug monitoring$15.08
- 80155Caffeine assayCaffeine concentration$38.57
- 80156Carbamazepine levelTotal concentration$14.57
- 80157Carbamazepine levelUnbound carbamazepine$13.25
- 80158Cyclosporine assayTherapeutic drug monitoring$18.05
- 80159Clozapine level$20.15
- 80162Digoxin assayTotal concentration$13.28
- 80163Digoxin assayFree concentration$13.28
- 80164Valproate levelTotal concentration$13.54
- 80165Valproic acidFree level$13.54
- 80168Ethosuximide level$16.34
- 80169Everolimus levelImmunosuppressant monitoring$13.73
- 80170Gentamicin assayTherapeutic drug monitoring$16.38
- 80171Gabapentin levelQuantitative drug level$21.67
- 80173Haloperidol levelTherapeutic drug assay$15.78
- 80175Lamotrigine levelQuantitative drug assay$13.25
- 80176Lidocaine assayDrug concentration$14.69
- 80177Levetiracetam levelQuantitative concentration$13.25
- 80178Lithium levelQuantitative drug monitoring$6.61
- 80180Mycophenolate levelQuantitative assay$18.05
- 80183Oxcarbazepine levelQuantitative concentration assay$13.25
- 80184Phenobarbital levelQuantitative drug assay$15.30
- 80185Phenytoin levelTotal drug concentration$13.25
- 80186Phenytoin levelUnbound concentration$13.76
- 80187Drug assayPosaconazole measurement$27.11
- 80188Primidone levelTherapeutic drug assay$16.59
- 80190Procainamide levelParent drug$60.00
- 80192Procainamide levelWith metabolites$16.75
- 80194Quinidine levelTherapeutic drug assay$14.60
- 80195Sirolimus levelWhole-blood drug level$13.73
- 80197Drug levelTacrolimus concentration$13.73
- 80198Theophylline levelDrug concentration assay$14.14
- 80199Tiagabine levelQuantitative drug assay$27.11
- 80200Tobramycin levelAntibiotic monitoring$16.13
- 80201Topiramate levelTopiramate-specific assay$11.92
- 80202Vancomycin levelAntibiotic concentration$13.54
- 80203Zonisamide levelQuantitative drug assay$13.25
- 80230Infliximab assayDrug measurement$38.57
- 80235Lacosamide assayDrug measurement$27.11
- 80280Vedolizumab assayDrug-specific measurement$38.57
- 80285Voriconazole assayDrug concentration$27.11
- 80299Drug assayUnlisted therapeutic drug$18.64
- 80305Drug screenDirect optical read$12.60
- 80306Drug screenInstrument-assisted optical read$17.14
- 80307Drug screenChemistry analyzer$62.14
- 80400ACTH panelTwo cortisol measurements$32.62
What changed in CLFS 2020 Q4
Compared with CLFS 2020 Q3 (effective Jul 1, 2020): 28 codes added and 1 with a new amount.
Added 28
| Test | CLFS 2020 Q4 amount |
|---|---|
| 0203UIBD gene profile17-gene whole-blood assay | Set by MAC |
| 0204UName pending | Set by MAC |
| 0205UGenetic AMD testThree variants, buccal swab | Set by MAC |
| 0206UAlzheimer cell testCultured skin fibroblasts | Set by MAC |
| 0207UAlzheimer assayPhosphorylated ERK imaging | Set by MAC |
| 0208UName pending | Set by MAC |
| 0209UGenome analysisConstitutional chromosome abnormalities | Set by MAC |
| 0210URPR testQuantitative immunoassay | Set by MAC |
| 0211UTumor sequencingDNA and RNA with therapy associations | Set by MAC |
| 0212UGenome analysisRare disease, proband | Set by MAC |
Showing 10 of 28.
New amounts 1
| Test | Before | Now |
|---|---|---|
| 0172UTumor gene assayBRCA1/2 and genomic instability | Set by MAC | $3,030.00 |
Largest changes first.
Related schedules and guides
- Medicare physician fee schedule: rates for physician services by payment locality, and the professional component of tests a physician interprets.
- Modifier 91: repeat clinical lab tests on the same day.
- Modifier 26: a physician’s interpretation, paid under the physician fee schedule.
- CPT and HCPCS code lookup: every code with a Medicare page.
Sources
Amounts come straight from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code with its payment indicator and amount. Contractor-priced tests are labeled, never given a made-up amount. Test names are written by FeeBase; CMS’s code descriptors aren’t reproduced.
CMS CLFS 2020 Q4 · effective Oct 1, 2020 through the day before Jan 1, 2021
