0634U Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Onc brst ca cfdna evl 11esr1.
National Average Payment
A national base rate is not currently published.
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Code Description
Oncology (breast cancer), cell-free dna (cfdna), evaluation of 11 esr1 variants (e380q, s463p, l536r, y537c, y537n, y537s, d538g, v422del, l536h, l536p, y537d) using droplet digital pcr (ddpcr), plasma, reported as positive or negative
Reimbursement Summary
CPT code 0634U (Oncology (breast cancer), cell-free dna (cfdna), evaluation of 11 esr1 variants (e380q, s463p, l536r, y537c, y537n, y537s, d538g, v422del, l536h, l536p, y537d) using droplet digital pcr (ddpcr), plasma, reported as positive or negative) does not currently have a published national facility or non-facility reimbursement rate in 2026.
0634U 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).
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
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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 0634U (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 0634U?
Medicare does not publish a single national reimbursement rate for 0634U in 2026 (No National Rate). Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to explore locality-adjusted estimates when applicable.
What is the description for code 0634U?
Oncology (breast cancer), cell-free dna (cfdna), evaluation of 11 esr1 variants (e380q, s463p, l536r, y537c, y537n, y537s, d538g, v422del, l536h, l536p, y537d) using droplet digital pcr (ddpcr), plasma, reported as positive or negative
Why do facility and non-facility payments differ for 0634U?
Facility vs. non-facility differences usually apply to RVU-based physician services. 0634U may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for 0634U?
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 0634U 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.
