Medicare Clinical Laboratory Fee Schedule Lookup
Medicare does not price a laboratory test under the Physician Fee Schedule. It uses the Clinical Laboratory Fee Schedule, which sets one national amount per code, the same in every state. Type a lab code and a date of service below and this tool answers from the CMS release in force that day. Free for 5 codes a day.
One national amount, per date of service
Results
80053. New York, date of service Oct 1, 2026.
The release behind these figures
Every amount above is computed from the CMS file below, held in a pinned archive so a number printed in a report can be produced again later, unchanged. The date of service chooses the file. Archive last rebuilt Oct 5, 2026.
- Release
- pfs-2026-10
- CMS file
- 2026 October (quarterly MPFSDB update, CR 14588)
- Prices dates of service
- Oct 1, 2026 onward
- Conversion factor
- $33.40
All 17 CMS physician releases in this archive
Source & method
- Amounts: the CMS Clinical Laboratory Fee Schedule public use file, every quarterly release from January 2023 to October 2026. A date of service is priced under the release CMS had in force that day. The figures on this page come from the 2026 October (CLFS quarterly update, CR 14569) release, read from PUF_CLFS_CY2026_Q4V1.txt inside the archived CMS file 26clabq4.zip (sha256 d6d0de8539519cc5).
- How they are read: CMS ships the same schedule twice and the two copies are not interchangeable, so each field is read from the copy that cannot mangle it. The amount comes from the text file, whose record layout fixes its picture. The short descriptor of a HCPCS Level II code (the G, P, Q and U codes) comes from the spreadsheet, PUF_CLFS_CY2026_Q4V1.csv, because one quarter’s text file quotes any descriptor containing a comma and then deletes the commas. Both copies are compared field by field on every rebuild.
- Contractor-priced rows: CMS writes 0.00 against pricing indicator “L”, which means it publishes no national amount and the Medicare contractor prices the test. Every one of those is carried as “no published amount”, never as $0.00. There are 118 of them in the October 2026 release.
- Descriptors: CMS’s short descriptor is shown for HCPCS Level II codes, which is CMS’s own text. For a CPT code, CMS publishes that descriptor under the American Medical Association’s license, so it is not shown, and the long CPT descriptors in the same file never were.
- CMS document for this release: 2026 October (CLFS quarterly update, CR 14569). CMS Clinical Laboratory Fee Schedule files.
Medicare lab rates, explained
What is the Medicare Clinical Laboratory Fee Schedule?
The Clinical Laboratory Fee Schedule is the price list Medicare uses for laboratory tests, and it is a different file from the Physician Fee Schedule. The Centers for Medicare & Medicaid Services publishes it as a public use file and reissues it quarterly. The 2026 October (CLFS quarterly update, CR 14569) release carries 2,117 HCPCS codes across 2,243 rows, of which 2,125 carry a published national amount and the remaining 118 are priced by the Medicare contractor. Every figure on this page is read directly from that file.
This schedule has no geography, and that is the point
One amount per code, identical in all 50 states, the District of Columbia and the territories. There is no locality, no state and no rural column, because CMS publishes none. That makes a lab line the simplest one on a bill to benchmark: the Medicare figure does not move when the laboratory does, so an argument that the test was performed in an expensive market has nothing in the fee schedule to attach to. Every other Medicare schedule this site carries varies by geography, which is why the physician lookup asks for a state and this schedule does not.
What Medicare pays for common lab tests
The table below lists October 2026 national amounts for 8 tests that show up on almost every injury bill, beside the amount in the 2023 April (CLFS quarterly update, CR 13082) file for the same code. 7 of the 8 are unchanged across the 14 quarterly reissues in between. 36415 moved from $8.57 to $9.34. Each amount is per test as the code defines it, and applies in every state.
| Code | October 2026 | April 2023 | CLIA-waived row |
|---|---|---|---|
| 80053 | $10.56 | $10.56 | QW, same amount |
| 85025 | $7.77 | $7.77 | QW, same amount |
| 80061 | $13.39 | $13.39 | QW, same amount |
| 84443 | $16.80 | $16.80 | QW, same amount |
| 83036 | $9.71 | $9.71 | QW, same amount |
| 81001 | $3.17 | $3.17 | none |
| 36415 | $9.34 | $8.57 | none |
| 84153 | $18.39 | $18.39 | none |
Source: CMS Clinical Laboratory Fee Schedule, 2026 October (CLFS quarterly update, CR 14569) (26clabq4.zip, PUF_CLFS_CY2026_Q4V1.txt) and 2023 April (CLFS quarterly update, CR 13082) (23CLABQ2.zip, CLAB2023Q2.txt).
Why the date of service decides the file
Because the membership of this schedule moves even when the money does not. Across the 16 releases in this archive, 265 rows first appear in an April, July or October file, 62 rows leave at some point (45 of them outside January), and four contractor-priced rows gain a published national amount mid-year. The sharpest case is the COVID-19 emergency set. All 5 of G2023, G2024, U0003, U0004 and U0005 are payable in the 2023 April (CLFS quarterly update, CR 13082) file, the highest of them at $75.00, and none of them appears in the 2023 July (CLFS quarterly update, CR 13195) file one quarter later. A year filter cannot express that. A date of service can.
| Code | Test | April 2023 | July 2023 |
|---|---|---|---|
| G2023 | Specimen collect covid-19 | $23.46 | not on the schedule |
| G2024 | Spec coll snf/lab covid-19 | $25.46 | not on the schedule |
| U0003 | Cov-19 amp prb hgh thruput | $75.00 | not on the schedule |
| U0004 | Cov-19 test non-cdc hgh thru | $75.00 | not on the schedule |
| U0005 | Infec agen detec ampli probe | $25.00 | not on the schedule |
Source: CMS Clinical Laboratory Fee Schedule, 2023 April (CLFS quarterly update, CR 13082) (23CLABQ2.zip) and 2023 July (CLFS quarterly update, CR 13195) (23CLABQ3.zip). 2023 April (CLFS quarterly update, CR 13082) prices dates of service from Apr 1, 2023; 2023 July (CLFS quarterly update, CR 13195) takes over from Jul 1, 2023.
Key terms on a clinical lab fee schedule row
- National amount
- The one figure CMS publishes for the code. It does not vary by state, locality or place of service.
- Pricing indicator N
- Nationally priced. CMS sets the amount and it is the figure shown.
- Pricing indicator L
- Priced by the Medicare contractor for the laboratory’s jurisdiction. CMS publishes no national amount and writes 0.00 in that column, which is not a price of zero. There are 118 such rows in the October 2026 release.
- QW
- The modifier that flags a CLIA-waived test. It records what the laboratory is certified to run, and in every release in this archive it carries the same amount as the unmodified row.
- Short descriptor
- The abbreviated test name CMS ships in the file, shown here for HCPCS Level II codes only. For a CPT code it is AMA-licensed text, as the long descriptor is, and neither is republished.
- Release
- One quarterly issue of the schedule, such as 2026 October (CLFS quarterly update, CR 14569). The release in force on the date of service is the one that prices the bill.
How bill reviewers use lab amounts
Medical billing experts use the Medicare lab amount to test whether a laboratory charge is reasonable. The workflow is to read the code off the claim, price it under the release CMS had in force on the date of service, and set that figure beside the billed charge. Because the schedule is national and each figure traces to a published CMS file, it holds up when challenged. For the professional and facility codes on the same bill, use the Medicare rate lookup. For injectable drugs billed on the same claim, see the Part B drug payment limits. For New Jersey no-fault claims, the state schedule is in the NJ PIP fee schedule lookup. For the full workflow from a stack of bills to a signed report, see Desk.
Medicare lab rates, answered
What is the Medicare Clinical Laboratory Fee Schedule?
It is the separate CMS price list for laboratory tests, and it is the schedule a lab charge is benchmarked against rather than the Physician Fee Schedule. The 2026 October (CLFS quarterly update, CR 14569) file carries 2,117 HCPCS codes across 2,243 rows. 2,125 of those rows carry a published national amount. CMS reissues the file every quarter, and this archive holds all 16 releases from January 2023 to October 2026.
Does the Medicare lab fee schedule vary by state?
No. This is the one Medicare schedule on this site with no geography at all. CMS publishes a single national amount per code, identical in every state, so there is no locality, no state and no rural split to choose. A lookup that asks you to pick a state for a lab test is inventing a distinction CMS does not make. The physician, ambulance and anesthesia schedules are priced by locality, and DMEPOS by state, which is why those tools ask and this one does not.
Why does a lab code show no rate, and does that mean Medicare pays nothing?
No. CMS marks those rows with pricing indicator "L", which means the Medicare contractor for the laboratory's jurisdiction sets the price and CMS publishes no national amount. CMS writes 0.00 in that column for exactly that reason, and a tool that prints $0.00 there is reporting a rate Medicare never set. The October 2026 file has 118 such rows, among them 81524. The honest answer for one of those codes is that there is no published figure, and that the amount has to come from the contractor.
Does the QW modifier change what Medicare pays for a lab test?
No. QW flags the test as CLIA-waived, which is a certification fact about the laboratory rather than a price. Across every release in this archive, January 2023 to October 2026, a QW row carries the same amount as its unmodified twin, and the build asserts that on every rebuild, so it can be stated flatly rather than hedged. Of the 8 common tests in the table on this page, 5 also appear with QW at the same amount.
Does the clinical lab fee schedule change during the year?
Yes, and the membership changes more than the money does. Across the 16 releases in this archive, 265 rows first appear in an April, July or October file, and pricing one of those against January's file returns no amount at all rather than a wrong one. 62 rows leave the schedule at some point, 45 of them in a non-January quarter. Four contractor-priced rows gain a published national amount mid-year. So a date of service, not a year, decides the file.
What happened to the COVID-19 lab codes G2023, G2024, U0003, U0004 and U0005?
All five are payable in the 2023 April (CLFS quarterly update, CR 13082) file and none of them survives into the 2023 July (CLFS quarterly update, CR 13195) file. G2023 was $23.46, G2024 was $25.46, U0003 was $75.00, U0004 was $75.00, U0005 was $25.00. A bill dated in the second quarter of 2023 therefore has a published Medicare amount for these codes and the same bill dated a quarter later does not, which is the clearest case on this schedule for pricing by date of service.
How do bill reviewers use the clinical lab fee schedule in an expert report?
They read the code off the claim, price it under the CMS release in force on the date of service, and set the Medicare amount beside the billed charge. Because the schedule is national, the same figure applies wherever the laboratory sits, which removes the geography argument entirely. Medicare-allowed is a floor-style benchmark: a reasonableness review normally pairs it with a percentage multiplier or with usual and customary data rather than using it as the conclusion on its own.