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Lab CPT Codes: Code Map, Rate Lookup, and Coding Rules

Updated Oct 30, 2026

Lab CPT codes are the five-character procedure codes, maintained by the American Medical Association (AMA), that a clinical laboratory puts on a claim to describe each test it performed. Most of them sit in the Pathology and Laboratory section of CPT (the 80000 series), with Proprietary Laboratory Analyses (PLA) codes that end in "U". Medicare pays most of these tests from the CMS Clinical Laboratory Fee Schedule (CLFS), and the CPT code is the key that links a test to its payment amount.

This guide maps the code families, shows how to find a rate in the official CMS file, and summarizes the coding rules that most often decide whether a lab claim is paid. CPT descriptors are copyrighted by the AMA, so this page paraphrases them. For exact descriptor wording, use a licensed CPT source from the AMA.

Code map: where lab tests live in CPT

The table below groups the lab code families by the type of testing. Ranges are approximate and are a navigation aid. Always confirm a specific code in the current CPT code set.

Code family Approximate range What it covers (paraphrased)
Organ or disease panels 80047–80081 Fixed groups of chemistry tests billed as one code, such as metabolic, lipid, and hepatic panels
Drug testing 80305–80377 Presumptive drug screens (80305–80307) and definitive drug identification
Therapeutic drug assays 80143–80299 Levels of specific medications
Urinalysis 81000–81099 Dipstick, microscopic, and pregnancy-by-visual-comparison urine tests
Molecular pathology 81105–81479 Gene-level and genomic sequencing procedures
Chemistry 82009–84999 Individual analytes such as glucose, A1c, and TSH
Hematology and coagulation 85002–85999 Blood counts, PT/INR, and other clotting studies
Immunology 86000–86849 Antibody and antigen detection, and immune function
Microbiology 87003–87999 Cultures, antigen detection, and nucleic-acid (PCR) detection of organisms
Proprietary Laboratory Analyses 0001U and up Single-lab or single-manufacturer tests, each with its own "U" code
Specimen collection (HCPCS/CPT) 36415, G0471 Venipuncture collection fee (see our CPT 36415 guide)

Sample Medicare rates from the current CMS file

These amounts come straight from the CMS CY 2026 Q4 CLFS file (26CLABQ4), the payment amount column, for the national rate. Rates are what Medicare Part B pays under the CLFS and do not tell you whether a test is covered. Payers other than Medicare set their own rates.

Code Plain-language test (paraphrased) CY 2026 Q4 CLFS amount QW row in file?
80048 Basic metabolic panel $8.46 Yes
80053 Comprehensive metabolic panel $10.56 Yes
80061 Lipid panel $13.39 Yes
83036 Hemoglobin A1c $9.71 Yes
84443 TSH $16.80 Yes
85025 Complete blood count with automated differential $7.77 Yes
85610 Prothrombin time $4.29 Yes
87635 SARS-CoV-2 nucleic-acid detection $51.31 Yes
87880 Strep A antigen, immunoassay with direct optical observation $16.53 Yes
36415 Venipuncture collection $9.34 No

Source: CMS CLFS Files, 26CLABQ4. Check the current quarterly file before quoting a rate, because CMS adds and changes codes every quarter.

How to look up a lab rate in the CMS CLFS

Step What to do
1 Open the CLFS Files page and download the newest quarterly release (for example, 26CLABQ4).
2 Unzip it. The archive has CSV, TXT, XLSX, and a PDF record layout.
3 Filter the HCPCS column for your code.
4 Check the MOD column. Many waived tests have a second row with QW.
5 Read the RATE column for the payment amount and EFF_DATE for when it took effect.
6 Confirm coverage separately. A listed amount does not mean Medicare covers the test (see local and national coverage determinations).

Coding rules that decide payment

Rule What it means in practice Primary source
Code what was performed Report the code that describes the method and analyte you actually ran, not a related or "close enough" code. AMA CPT
Panel integrity Bill a panel code only when every component test of that panel was performed. Otherwise, bill the components individually. AMA CPT panel instructions
CLIA certificate must match complexity Medicare edits lab claims against the lab's CLIA certificate. A waived-only lab can be paid only for waived tests. 42 CFR 493; CMS CLIA
QW modifier for waived tests Most waived tests need QW on the claim. Nine codes are exempt. CMS waived-test transmittal; see our QW modifier guide
One collection fee per encounter 36415 is paid once per patient encounter, however many tubes are drawn. CMS Claims Processing Manual, Ch. 16 §60.1
No coinsurance on CLFS tests Medicare Part B deductible and coinsurance generally do not apply to CLFS-paid tests or to specimen collection fees. CMS Claims Processing Manual, Ch. 16

Where compliance meets coding

Coding errors in a lab often start upstream. A test gets added to the menu without a CLIA complexity check, QC isn't documented for a waived kit, or a method changes without anyone updating the code. myLabCompliance.io keeps test menus, instrument and kit records, QC, personnel competency, and documents in one place. Billing staff and lab directors can then see what a lab is certified to run before a claim goes out.

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FAQs

What is the difference between CPT and HCPCS codes for lab tests?

CPT (HCPCS Level I) is the AMA's code set. HCPCS Level II codes, such as G0471 or the G0480–G0483 definitive drug codes, are created by CMS. The CLFS file lists both in a single "HCPCS" column.

Where can I find the official Medicare rate for a lab CPT code?

Use the newest quarterly file on the CMS CLFS Files page. The RATE column holds the payment amount.

Are lab CPT codes the same for Medicare and commercial payers?

The codes are the same. Payment amounts and coverage policies are different. Commercial contracts set their own rates, often as a percentage of the CLFS.

What are PLA codes?

Proprietary Laboratory Analyses codes are CPT codes that end in "U" and identify one lab's or one manufacturer's test. CMS lists many of them in the CLFS (for example, 0001U).

Can I bill a panel code if one component wasn't run?

No. Under CPT panel conventions, every listed component must be performed. If one is missing, report the components you did perform as individual codes.

Do I need a QW modifier on every waived test?

Not on every one. CMS exempts nine codes (81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, 85651). Most other waived tests need QW. See our QW guide.

Can I copy CPT descriptors into my own materials?

CPT descriptors are copyrighted by the AMA. Using them in software or publications generally requires an AMA license.

How often do lab codes and rates change?

CPT updates every year, and CMS issues CLFS files every quarter (Q1–Q4). Check the newest file before quoting a rate.

Sources