The $572 Million Code Medicare Never Priced
CPT 81479 carries no rate on the clinical laboratory fee schedule. Medicare paid $572.2 million on it in 2024, and the twelve labs that collected 94.6% of that averaged anywhere from $1,661 to $7,099 a test.
The third-quarter clinical laboratory fee schedule prices 2,206 lines for 2026 dates of service. 321 of them are five-digit codes in the molecular pathology block, running 81000 through 81596, and they range from a few dollars to $12,000 for a comparator exome.
81479 is not among them. Neither is 81599.
Search the file for either string and you get nothing.
Medicare paid $572.2 million on 81479 in calendar 2024.
"What does a revenue-cycle team budget against a code with no published rate?"
Twelve Labs, One Code, and Four Times the Spread
The national row is 232,816 services for 183,888 beneficiaries, billed by 132 rendering providers, at an average Medicare payment of $2,457.65. Submitted charges averaged $5,989.99, so the allowance lands at 41.0% of what was billed.
Allowed equals paid to the cent on both codes, which is the clinical-lab coinsurance rule showing up in the data.
Break that national average into the labs behind it and it stops being one number (chart above). Adaptive Biotechnologies averaged $7,099.03 per service in Washington, and Invitae averaged $1,661.25 in California.
Ten more sit in between, and the three largest by dollars, Natera, CareDx and Caris MPI, took 53.7% of the money between them.
Seventy-six named labs appear in the provider file. Twelve of them collected 94.6% of the $572.1 million it accounts for.
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