0659U Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Rare ds ultrapid wgsalys dna.
National Average Payment
Non-Facility (Private Office) Rate
0659U Reimbursement Rate History
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
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Code Description
Rare diseases (constitutional/heritable disorders), ultrarapid whole genome sequence analysis of nuclear and mitochondrial dna by next-generation sequencing (ngs) for single-nucleotide variants (snvs), insertions/deletions, copy number variants, uniparental disomy, and repeat expansions, using blood or buccal sample, identification and categorization of genetic variants
Reimbursement Summary
CPT code 0659U (Rare diseases (constitutional/heritable disorders), ultrarapid whole genome sequence analysis of nuclear and mitochondrial dna by next-generation sequencing (ngs) for single-nucleotide variants (snvs), insertions/deletions, copy number variants, uniparental disomy, and repeat expansions, using blood or buccal sample, identification and categorization of genetic variants) does not currently have a published national facility or non-facility reimbursement rate in 2026.
0659U 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).
0659U Reimbursement Rate History
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | — | — | — | — | — | — |
Historical Medicare Reimbursement
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 | — | — | — | — |
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.
Commercial Payer Rates for 0659U
Pro FeatureNational 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 (Office) Payment
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For 0659U (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 0659U?
Medicare does not publish a single national reimbursement rate for 0659U 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 0659U?
Rare diseases (constitutional/heritable disorders), ultrarapid whole genome sequence analysis of nuclear and mitochondrial dna by next-generation sequencing (ngs) for single-nucleotide variants (snvs), insertions/deletions, copy number variants, uniparental disomy, and repeat expansions, using blood or buccal sample, identification and categorization of genetic variants
Why do facility and non-facility payments differ for 0659U?
Facility vs. non-facility differences usually apply to RVU-based physician services. 0659U may not use both facility and non-facility pricing depending on its payment methodology.
How can I find my local Medicare rate for 0659U?
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 0659U 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.
