The 2026 clinical lab fee schedule sets payment for CPT code 81195 at $1,853.22, up from $1,263.53 in 2025.
The Centers for Medicare & Medicaid Services (CMS) has increased the reimbursement rate for optical genome mapping used in hematologic malignancy testing by 47% in its 2026 clinical lab fee schedule.
The payment determination for CPT code 81195 will rise from $1,263.53 to $1,853.22, effective Jan 1, 2026. The code applies to cytogenomic genome-wide analysis using optical genome mapping to detect structural and copy number variations related to blood cancers.
CMS initially established the 2025 payment rate based on a crosswalk to an existing code. Following a request for reconsideration and crosswalk to a different code with a higher payment rate, the clinical diagnostic laboratory test committee voted unanimously 10-0 in favor of the proposed change. CMS agreed with the panel recommendation and repriced the code accordingly.
The decision affects reimbursement for optical genome mapping-based laboratory-developed tests offered by Bionano Laboratories, a subsidiary of Bionano Genomics Inc. These tests serve as alternatives to traditional cytogenetics methods including karyotyping, fluorescence in-situ hybridization, and microarrays.
Two CPT codes now cover optical genome mapping applications: 81195 for hematologic malignancy analysis and 81354 for constitutional genetic disease testing. Bionano Laboratories offers three tests expected to be covered by these codes: OGM-Dx HemeOne, OGM-Dx Postnatal Whole Genome SV, and OGM-Dx Prenatal Whole Genome SV.
“We believe the increase in the CLFS for the Category 1 CPT code 81195 will make it easier to offer OGM-based LDTs for hematologic malignancies due to the potentially more favorable reimbursement from payers,” says Alka Chaubey, chief medical officer of Bionano, in a release. “We believe the newly established payment level, which is substantially higher than the original pricing, is appropriate for the additional data collection, interpretation, and reporting needed when using OGM for blood cancers.”
The establishment of Category I CPT codes may increase awareness of optical genome mapping utility in oncology and clinical genetic testing communities both domestically and internationally, according to Chaubey.
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