Priced under CLFS
84100 · CLFS Q4 2026
National CLFS allowed amount · Q4 2026
$4.74
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 evidenceAmount evidence: Clinical Laboratory Fee Schedule
Effective Jan 1, 2026 · Lab payment rules and source details
Inspect PFS status evidence
- Code
- 84100
- 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 10,353 in rvu26d-updated-08-26-2026.zip
In the CMS file
Loading rows 10,351–10,355 of PPRRVU2026_Oct_nonQPP.csv…
Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint
4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626
The national CLFS allowed amount is $4.74 for CPT 84100 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 84100 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 84100?
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 84100 Copy link
Priced under the Clinical Laboratory Fee Schedule, not the Physician Fee Schedule
84100 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
$4.74
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.
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
- 84100
- Modifier
- Blank
- Pricing indicator
- N
- Allowed amount
- $4.74
- Effective date
- 2026-01-01
- File SHA-256
- fcfec34526c443902747deae74339aae6f8bc79f26b3239cc017c278bf730e0e
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust 84100's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 84100 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
- 1 code forms an NCCI pair with 84100 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
- 1 code pairs with 84100 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 84100'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.
CMS RVU26DOctober 1 – December 31, 2026revision 2
Can you bill it with another code? Copy link
84100 has 2 NCCI pairs (Q4 2026) and an MUE of 2 units per patient per date of service.
Modifier indicator 1
1 pair
Only with an appropriate, documented modifier
- 80069 80069 Renal Function Panel View rate & details →
Medically Unlikely Edit (MUE) limit
2 units
Per patient per date of service
Source & method Copy link
The lab amount comes from the Clinical Laboratory Fee Schedule record shown above.
-
01 PUF_CLFS_CY2026_Q4V1.csv · CLFS Q4 2026 · row 1,396—the lab amount limits
- Effective
- Effective 2026-01-01
- Locator
- CMS source
- Note
- Its release and effective date are independent of the PFS release used for status evidence.
-
02 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 10,353—status X
- Effective
- October 1 – December 31, 2026
- Locator
- PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 10,353 of 19,453 · via CMS
- Fields read
-
Status X (col 4)SHA-256 4d0d3f19bd954ffc…
-
03 NCCI · Q4 2026—the code-pair edits
- Source
- National Correct Coding Initiative (NCCI)
- Effective
- Same quarter as the Q4 2026 rate
-
04 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q4 2026 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume, or the exact place of service: CMS publishes only the facility vs non-facility split, so the Office (non-facility) share does not identify urgent care or any other specific setting.
- Note
- The dataset suppresses rows under 11 beneficiaries. Specialty groups with fewer than 30 observed clinicians are omitted, so the shares can fall short of 100%.
Cite this rate
CPT 84100: $4.74 (CLFS Q4 2026; effective 2026-01-01). PUF_CLFS_CY2026_Q4V1.csv, row 1396. Localis. https://localishealth.com/sources/clinical-lab-fee-schedule/2026/D
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
— Office (non-facility) and — Facility since Jan 1, 2013.
-
Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- —
- Facility
- —
-
Jan 1, 2013 – present
Q1 2013
Still in effect · 53 releases at this rate- Office
- —
- Facility
- —
Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013 · Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014 · Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015 · Q4 2015 Oct 1, 2015 – Dec 31, 2015 · Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016 · Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017 · Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018 · Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019 · Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020 · Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021 · Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022 · Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023 · Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
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.
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Usage and related codes Copy link
In CY2024, 84100 ranked #174 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 1.8M
- Allowed
- $8.3M
- Beneficiaries
- 887,331
Who bills 84100 to Medicare
100% Office (non-facility) · 0% facility- Hematology/Oncology 32%
- Internal Medicine 17%
- Nephrology 13%
- NP/PA 11%
- Family Medicine 8%
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.