Pathology & LaboratoryStatus X

CPT Code 81235

Genetic test for EGFR gene variants (lung cancer treatment planning)

Source: CMS 2026 Clinical Laboratory Fee ScheduleEffective Reviewed by the D3rx Clinical Billing Team

2026 CLFS pricing

CLFS national limit

$324.58

National limit · 2026

CPT 81235 is not priced under the Physician Fee Schedule (status X). Laboratory tests are reimbursed under the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule. Actual payment is the lesser of the billed charge or this national limit, and some states' fee schedules differ.

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Laboratory pricing note

Clinical laboratory tests like 81235 are generally reimbursed under the Medicare Clinical Laboratory Fee Schedule (CLFS), which sets a national limitation amount per test rather than RVU-based PFS pricing. Bill the test on a CMS-1500/837P with the ordering diagnosis; payment follows the CLFS amount for the date of service.

Related Pathology & Laboratory codes

8005383036850258006188305803078230681003

Related guides

Medical billing disclaimer

Rates shown are 2026 Clinical Laboratory Fee Schedule amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.