localis
Calculator

Describe a service in plain words, or type a CPT/HCPCS code.

CPT 81015 Medicare lab fee

Priced under CLFS

81015 · CLFS Q4 2026

National CLFS allowed amount · Q4 2026

$3.05

National lab fee-schedule amount, before sequestration. No locality adjustment applies to this amount.

No Physician Fee Schedule amount—priced under the Clinical Laboratory Fee Schedule.

View CLFS amount and evidence
View CMS source and method

Amount evidence: Clinical Laboratory Fee Schedule

Clinical Laboratory Fee Schedule (Q4 2026) · 26clabq4.zip (PUF_CLFS_CY2026_Q4V1.csv row 749)

Effective Jan 1, 2026 · Lab payment rules and source details

Inspect PFS status evidence
Code
81015
Release
Q4 2026, revision 2
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU2026_Oct_nonQPP.csv row 9,744 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 9,742–9,746 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Plain-text summaryReport a problem

The national CLFS allowed amount is $3.05 for CPT 81015 under the Clinical Laboratory Fee Schedule (CLFS)—a single national rate, the same in every locality, before the ~2% sequestration cut. On the Physician Fee Schedule CPT 81015 carries status X (statutory exclusion) because lab services are paid under the CLFS instead. Figure from the Q4 2026 CLFS file, effective January 1, 2026.

Why is there no national PFS amount for 81015?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. The lab schedule supplies the pricing information shown above. See the CLFS evidence.

The Medicare lab fee for 81015 Copy link

Priced under the Clinical Laboratory Fee Schedule, not the Physician Fee Schedule

81015 carries status X on the Physician Fee Schedule because Medicare pays for clinical lab tests under a separate fee schedule, the CLFS. Since 2018 the CLFS rate is a single national amount—the same in every state and setting, with no locality adjustment.

Original Medicare generally pays 100% of the CLFS amount for covered clinical diagnostic lab tests—no Part B coinsurance or deductible, unlike most physician services.

National CLFS rate

$3.05

Q4 2026 CLFS file · effective Jan 1, 2026

Before the ~2% sequestration cut applied at claim payment. Lab tests billed by a hospital outpatient department may be packaged into the facility payment instead.

Clinical Laboratory Fee Schedule (Q4 2026) · 26clabq4.zip (PUF_CLFS_CY2026_Q4V1.csv row 749)

This record establishes the published lab amount and its effective date. It does not establish patient-specific coverage or whether a claim is packaged into another payment.

Source fields and checksum
Code
81015
Modifier
Blank
Pricing indicator
N
Allowed amount
$3.05
Effective date
2026-01-01
File SHA-256
fcfec34526c443902747deae74339aae6f8bc79f26b3239cc017c278bf730e0e

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

NCCI same-day edits Applies MUE behavior Applies Other fee-schedule routing Applies Rendering provider percentage Context required
Other payment indicators (7)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, Contractor pricing: Does not apply.
Why would a Medicare claim for 81015 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. Medicare prices this code under the Clinical Laboratory Fee Schedule instead; the CLFS rate is shown on this page. See CLFS rate
  • 7 codes form NCCI pairs with 81015 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 11 codes pair with 81015 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • More than 2 units per patient per date of service exceeds 81015's Medically Unlikely Edit (MUE) limit. See billing together

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Which billing rules and modifiers apply? Copy link

Global period: what 81015's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for 81015 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 81015 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

81000 81015 denies
81001 - Urine Test With Microscope Exam 81015 denies
81002 - Manual Urinalysis 81015 denies

Showing 3 of 7.

Separately payable with 81015 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

00100 81015 denies
00102 81015 denies
00103 81015 denies

Showing 3 of 11.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 18 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 2 units per patient per date of service.

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 81015 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

How often 81015 is billed Copy link

Across Original Medicare in CY2024, 81015 ranked #774 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
114,391
Office + facility beneficiaries combined
Services
145,433
Times it was billed
Allowed
$433,888
Total Medicare allowed dollars
Compare: ↑ #773 more popular · 72156 ↓ #776 less popular · 93886

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2026 fee schedule above.

Did this answer your question about CPT 81015?

Tell us what you were trying to work out and we'll answer you or build the page that does.

Did this page answer your question?

Source & method

Show sources

The lab amount comes from the Clinical Laboratory Fee Schedule record shown above. Its release and effective date are independent of the PFS release used for status evidence. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 9,744)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 81015: $3.05 (CLFS Q4 2026; effective 2026-01-01). PUF_CLFS_CY2026_Q4V1.csv, row 749. Localis. https://localishealth.com/sources/clinical-lab-fee-schedule/2026/D