Medicare Clinical Laboratory Fee Schedule 2026 (October)

The October 2026 file in numbers

Code and modifier rows

2,243

2,117 distinct codes

National payment amounts

2,125

118 rows priced by the contractor

CLIA-waived (QW) rows

126

126 at the same amount as the base code

PLA codes

617

four digits and U

HCPCS Level II lab codes

42

G, P, Q and U codes

Median national amount

$35.09

$2.17 to $12,000.00

Each row of the file carries the year, the code, an optional modifier, the date the amount took effect, a pricing indicator and the payment rate. The indicator is N when CMS sets a national payment amount that every Medicare Administrative Contractor pays, and L when the code is priced locally by the Medicare Administrative Contractor; locally priced rows show a rate of zero in the file. Most rows took effect on January 1, 2026; 88 rows carry a later date (1 on 2026-03-24, 17 on 2026-04-01, 1 on 2026-05-15, 30 on 2026-07-01, 39 on 2026-10-01), the quarterly additions CMS makes as new codes are created.

How Medicare pays a laboratory test

The CLFS is a single national schedule: unlike the physician fee schedule there are no geographic practice cost indices and no locality adjustment, so a test pays the same national amount in Manhattan and in rural Arkansas. Part B pays the lesser of the amount the laboratory bills and the fee schedule amount, and clinical diagnostic laboratory tests carry neither the Part B deductible nor coinsurance, so the amount in the file is what Medicare pays for a covered test. Since 2018 most national amounts have been set from the private payer rates that applicable laboratories report to CMS under the Protecting Access to Medicare Act of 2014 (section 1834A of the Social Security Act), using a weighted median of those rates for each code.

A laboratory test is paid from the CLFS only when it is billed on its own. The professional component of certain pathology services is a physician fee schedule service, tests furnished during an inpatient stay are bundled into the MS-DRG payment, and tests on a hospital outpatient claim are usually packaged into the OPPS payment for the visit or procedure (status indicator Q4 marks laboratory codes that are packaged unless they are the only services on the claim). The Medicare fee lookup returns the CLFS amount, the physician fee schedule row and the OPPS status indicator for a code side by side, so the three answers can be compared.

National amounts by code range

How the national amounts are spread

HCPCS Level II laboratory codes on the CLFS

The highest national amounts

What changed from July to October 2026

Comparing the fourth-quarter file with the third-quarter file (26CLABQ3, 2,206 rows) row by row, 40 rows are new, 3 are gone and no rate on a row present in both files changed. 39 of the new rows take effect on October 1, 2026; 39 of them are priced locally until CMS sets a national amount, the rest carry an earlier effective date because CMS added them retroactively to the date the code became valid.

No longer on the October file: 0556U ($142.63 in July), 0557U ($262.99 in July), 0585U ($2,919.60 in July).

Laboratory NCDs and their national amounts

The 23 laboratory national coverage determinations govern common tests through a national edit: the procedure codes each one names are paid only when the claim carries a diagnosis the NCD's ICD-10-CM list supports. 23 of them name codes with a national amount on this file. Each NCD page lists its procedure codes with these amounts and the covered and non-covered diagnosis codes.

Billing notes that change the amount

Modifier QW tells the contractor that a test on the CLIA-waived list was performed by a laboratory holding a certificate of waiver; without it, a waived laboratory's claim for that test is denied for CLIA reasons even though the amount is the same. Medically unlikely edits cap the units of many laboratory codes per day, and NCCI procedure-to-procedure edits bundle component tests into panels, so the MUE lookup and the NCCI checker answer the questions a lab line raises before it is priced. Coverage for tests outside the national laboratory NCDs is decided locally; the LCD lookup finds the contractor policies that list a code.

Hospital laboratories that bill on the 13x outpatient type of bill use the same CLFS amounts for tests that are not packaged, and the OPPS status indicator page explains when the Q4 conditional packaging applies. Other fee schedules on this site: the physician fee schedule for pathology interpretations and the fee schedules hub for the full map.

Frequently asked questions

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

• Clinical Laboratory Fee Schedule public use file, 2026 fourth quarter (26CLABQ4)
  Version 26CLABQ4 (CY2026 Q4) · effective 2026-10-01 · file PUF_CLFS_CY2026_Q4V1.csvSHA-256 fcfec34526c44390…
• Clinical Laboratory Fee Schedule public use file, 2026 third quarter (26CLABQ3)
  Version 26CLABQ3 (CY2026 Q3) · effective 2026-07-01 · file PUF_CLFS_CY2026_Q3V1.csvSHA-256 f5a090789c40fe79…
• HCPCS Level II alpha-numeric file, October 2026
  Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
• Laboratory NCD ICD-10 code lists, October 2026
  Version October 2026 · effective 2026-10-01 · file 2026400-Initial-ICD10-NCD-Spreadsheet-20260601-508.xlsxSHA-256 ec4361dc65f63432…