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Current CMS pricing and breakdown for Hered rta do gen seq 15.
Non-Facility (Private Office) Rate
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $597.91 | $597.91 | $597.91 | $597.91 | $597.91 | $597.91 |
This item has a standard price nationwide. Your local rate will likely match the amount shown above.
Hereditary retinal disorders (eg, retinitis pigmentosa, leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including abca4, cnga1, crb1, eys, pde6a, pde6b, prpf31, prph2, rdh12, rho, rp1, rp2, rpe65, rpgr, and ush2a
CPT code 81434 (Hereditary retinal disorders (eg, retinitis pigmentosa, leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including abca4, cnga1, crb1, eys, pde6a, pde6b, prpf31, prph2, rdh12, rho, rp1, rp2, rpe65, rpgr, and ush2a) had a 2026 Medicare non-facility reimbursement rate of $597.91. This reflects a 0.00% change from the prior year.
The 2026 National Medicare reimbursement for 81434 is $597.91. This item is paid at a standard national rate, so local variation is typically minimal.
Description: Hereditary retinal disorders (eg, retinitis pigmentosa, leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencin.... Payment policies and coverage rules can still vary by setting and claim details, so confirm final guidance through CMS when needed.
| Quarter | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 | Q3 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $597.91 | $597.91 | $597.91 | $597.91 | $597.91 | $597.91 |
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $597.91 | $597.91 | +0.00% | +0.00% |
| 2026 Q2 | $597.91 | $597.91 | +0.00% | +0.00% |
| 2026 Q1 | $597.91 | $597.91 | +0.00% | +0.00% |
| 2025 Q4 | $597.91 | $597.91 | — | — |
| 2025 Q3 | $597.91 | $597.91 | — | — |
| 2025 Q2 | $597.91 | $597.91 | — | — |
| 2025 Q1 | $597.91 | $597.91 | — | — |
| 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 81434 (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.
The 2026 National Average Medicare reimbursement rate for 81434 (Clinical Laboratory Test) is $597.91. This rate is effective as of January 1, 2026.
Hereditary retinal disorders (eg, retinitis pigmentosa, leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including abca4, cnga1, crb1, eys, pde6a, pde6b, prpf31, prph2, rdh12, rho, rp1, rp2, rpe65, rpgr, and ush2a
Facility vs. non-facility differences usually apply to RVU-based physician services. 81434 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.