0538U Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Onc sol tum ngts ffpe 600gen.
National Average Payment
National Medicare Payment
$2,989.55
This fee schedule does not publish separate facility and non-facility rates for this code.
Effective Q3 2026
ℹ️ Good to Know
This item has a standard price nationwide. Your local rate will likely match the amount shown above.
Historical Medicare Reimbursement
| Quarter | National Medicare Payment | YoY % Change |
|---|---|---|
| 2026 Q3 | $2,989.55 | — |
| 2026 Q2 | $2,989.55 | — |
| 2026 Q1 | $2,989.55 | — |
| 2025 Q4 | — | — |
| 2025 Q3 | — | — |
| 2025 Q2 | — | — |
| 2025 Q1 | — | — |
Code Description
Oncology (solid tumor), nextgeneration targeted sequencing analysis, formalin-fixed paraffinembedded (ffpe) tumor tissue, dna analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number alterations, microsatellite instability, tumor mutation burden, reported as actionable variant
Reimbursement Summary
CPT code 0538U (Oncology (solid tumor), nextgeneration targeted sequencing analysis, formalin-fixed paraffinembedded (ffpe) tumor tissue, dna analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number alterations, microsatellite instability, tumor mutation burden, reported as actionable variant) had a 2026 Medicare non-facility reimbursement rate of $2,989.55.
The 2026 National Medicare reimbursement for 0538U is $2,989.55. This item is paid at a standard national rate, so local variation is typically minimal.
Description: Oncology (solid tumor), nextgeneration targeted sequencing analysis, formalin-fixed paraffinembedded (ffpe) tumor tissue, dna analysis of 600 genes, interrogati.... Payment policies and coverage rules can still vary by setting and claim details, so confirm final guidance through CMS when needed.
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. Non-Facility (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For 0538U (Clinical Laboratory Test), the payment methodology may not include both facility and non-facility rates.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 0538U?
The 2026 National Average Medicare reimbursement rate for 0538U (Clinical Laboratory Test) is $2,989.55. This rate is effective as of January 1, 2026.
What is the description for code 0538U?
Oncology (solid tumor), nextgeneration targeted sequencing analysis, formalin-fixed paraffinembedded (ffpe) tumor tissue, dna analysis of 600 genes, interrogation for single-nucleotide variants, insertions/deletions, gene rearrangements, and copy number alterations, microsatellite instability, tumor mutation burden, reported as actionable variant
Why do facility and non-facility payments differ for 0538U?
Facility vs. non-facility differences usually apply to RVU-based physician services. 0538U may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for 0538U?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 0538U covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
