Why lab codes show status X Copy link
On the Physician Fee Schedule, clinical lab tests carry status X: outside the statutory definition of physician services. CMS names clinical diagnostic lab tests as an example. Status X is not a coverage exclusion. It means the test is paid from another fee schedule, the CLFS.
One national amount Copy link
A CLFS amount has no GPCIs and no facility or non-facility split. Original Medicare generally pays 100% of the CLFS amount for covered clinical diagnostic lab tests, with no Part B deductible or coinsurance, unlike most physician services. The roughly 2% sequestration reduction still applies when the claim is paid. Lab tests billed by a hospital outpatient department may be packaged into the facility payment instead.
Tests with no national amount Copy link
Some codes appear in the CLFS file with no national rate. Their pricing indicator tells the Medicare Administrative Contractor to set the amount, typically for a new or proprietary test awaiting national pricing. The zero in that row is a placeholder, not a price.
Interpretations stay on the PFS Copy link
A physician’s interpretation of certain lab results is paid under the Physician Fee Schedule even though the test itself is paid from the CLFS. These codes carry PC/TC indicator 6.
Waived tests Copy link
Tests performed with a CLIA-waived system may need modifier QW to pass the certificate edit. The QW and non-QW versions of a code carry the same CLFS amount. See CPT 85610 for a lab code’s CLFS amount and its source file.
Look up a lab fee schedule amount Copy link
Enter a lab code to see its national Clinical Laboratory Fee Schedule amount from the latest CLFS file.
Try , , ,
85610 · CLFS Q4 2026 file · effective Jan 1, 2026
The national lab fee schedule amount for 85610 is $4.29.
See 85610’s code page and source file
One national amount, the same in every state and setting. Original Medicare generally pays covered clinical lab tests at 100% of it, with no deductible or coinsurance.
Frequently asked Copy link
Does the Medicare lab fee schedule vary by location?
No. Since 2018 each CLFS rate is a single national amount, the same in every state and setting.
Do patients pay coinsurance for Medicare lab tests?
Original Medicare generally pays 100% of the CLFS amount for covered clinical diagnostic lab tests, with no Part B deductible or coinsurance.
Why does a lab code show no Physician Fee Schedule rate?
Clinical lab tests carry status X on the Physician Fee Schedule because they are paid from the Clinical Laboratory Fee Schedule instead. Look up the CLFS amount for the code.
Sources Copy link
- CMS Clinical Laboratory Fee Schedule
- CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field)
- CMS Clinical Laboratory Improvement Amendments (CLIA)
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
Did this answer your question about The Medicare Clinical Laboratory Fee Schedule?
Tell us what you were trying to work out and we'll answer you or build the page that does.