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Current CMS pricing and breakdown for Onc brst mrna gen prflg 80.
Non-Facility (Private Office) Rate
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
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Oncology (breast), mrna, gene expression profiling by microarray of 80 genes (80 content and 465 housekeeping), utilizing formalin-fixed paraffinembedded tissue (ffpe), algorithm reported as an index that is diagnostic of a molecular subtype (luminal, basal, her2)
CPT code 0630U (Oncology (breast), mrna, gene expression profiling by microarray of 80 genes (80 content and 465 housekeeping), utilizing formalin-fixed paraffinembedded tissue (ffpe), algorithm reported as an index that is diagnostic of a molecular subtype (luminal, basal, her2)) does not currently have a published national facility or non-facility reimbursement rate in 2026.
0630U is a CPT code in the category “Clinical Laboratory Test.” Medicare does not publish a single national payment amount for this code in 2026 (No National Rate). A national base rate is not currently published.
To estimate a local payment amount when available, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage and confirm final pricing guidance through CMS or your local Medicare Administrative Contractor (MAC).
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
No published quarterly historical rates are available yet for this code.
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | — | — | — | — |
| 2026 Q2 | — | — | — | — |
| 2026 Q1 | — | — | — | — |
| 2025 Q4 | — | — | — | — |
| 2025 Q3 | — | — | — | — |
| 2025 Q2 | — | — | — | — |
| 2025 Q1 | — | — | — | — |
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
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.
National average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For 0630U (Clinical Laboratory Test), the payment methodology may not include both facility and non-facility rates.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Medicare does not publish a single national reimbursement rate for 0630U in 2026 (No National Rate). Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to explore locality-adjusted estimates when applicable.
Oncology (breast), mrna, gene expression profiling by microarray of 80 genes (80 content and 465 housekeeping), utilizing formalin-fixed paraffinembedded tissue (ffpe), algorithm reported as an index that is diagnostic of a molecular subtype (luminal, basal, her2)
Facility vs. non-facility differences usually apply to RVU-based physician services. 0630U may not use both facility and non-facility pricing depending on its payment methodology.
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.
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.