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CPT 85347

Priced under CLFS

85347 · CLFS Q3 2026

National CLFS allowed amount · Q3 2026

$4.28

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

The national CLFS allowed amount is $4.28 for CPT 85347 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 85347 carries status X (statutory exclusion) because lab services are paid under the CLFS instead. Figure from the Q3 2026 CLFS file, effective January 1, 2026.

Amount evidence: Clinical Laboratory Fee Schedule

Clinical Laboratory Fee Schedule (Q3 2026) · 26clabq3.zip (PUF_CLFS_CY2026_Q3V1.csv row 1,538)

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

Inspect PFS status evidence
Code
85347
Release
Q3 2026, revision 1
Result
Priced under CLFS

Citations

  • Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

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

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 10,465)
    hcpcs (col 1)
    85347
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

Compact facts

Why is there no national PFS amount for 85347?

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.

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

NCCI same-day edits Applies Other fee-schedule routing Applies
Other payment indicators (8)

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, MUE behavior: Not determined, Contractor pricing: Does not apply.

The Medicare lab fee for 85347 Copy link

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

85347 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

$4.28

Q3 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 (Q3 2026) · 26clabq3.zip (PUF_CLFS_CY2026_Q3V1.csv row 1,538)

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
85347
Modifier
Blank
Pricing indicator
N
Allowed amount
$4.28
Effective date
2026-01-01
File SHA-256
f5a090789c40fe791b478a735c7cf5399e86726adc788f11829435cb0ca4d7d5
Payment rules

Global period: what 85347'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

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 85347.

See every current NCCI pair for 85347 →

Billing together (NCCI edits) Copy link

NCCI Q3 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 85347 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

96523 96523 denies

Separately payable with 85347 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

80503 80503 denies
80504 80504 denies
80505 80505 denies

Showing 3 of 6.

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 7 NCCI pairs →

Common payment questions Copy link

Why would a Medicare claim for 85347 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 85347 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
  • 6 codes pair with 85347 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

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.

History

Rate history by release Copy link

National non-facility amount for 85347 across quarterly releases.

Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 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 & related

How often 85347 is billed Copy link

Across Original Medicare in CY2024, 85347 ranked #4,391 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.7 times on average that year.

Beneficiaries
988
Office + facility patients combined
Services
1,663
Times it was billed
Allowed
$6,942
Total Medicare allowed dollars
Compare: ↑ #4,386 more popular · 65286 ↓ #4,392 less popular · 68420

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 Q3 2026 fee schedule above.

Did this answer your question about CPT 85347?

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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. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 10,465)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 85347: $4.28 (CLFS Q3 2026; effective 2026-01-01). PUF_CLFS_CY2026_Q3V1.csv, row 1538. Localis. https://localishealth.com/sources/clinical-lab-fee-schedule/2026/C