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See a sample rate comparisonCPT 0016U Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
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| Key Fact | Detail |
|---|---|
| Service Type | Proprietary Laboratory Analyses |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 0016U |
| Medicaid Fee Schedule | View Medicaid rates for 0016U |
National average reimbursement for CPT 0016U by major payers:
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CPT 0016U
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$360.71Published rateChristopher Raio
St Joseph Hospital
$202.22Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$149.27Published rateChristopher Raio
St Francis Hospital
$88.54Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$80.97Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 0016U vs. Other Proprietary Laboratory Analyses Codes
The CPT 0016U code is part of the Proprietary Laboratory Analyses services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 0016U code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 0016U-CPT | Moderate | Onc Hmtlmf Neo Rna Bcr Abl1 Bld Bne Marrow, Oncology (Hematolymphoid Neoplasia) Rna Bcr Abl1 Major And Minor Breakpoint Fusion Transcripts Quantitative Pcr Amplification Blood Or Bone Marrow Report Of Fusion Not Detected Or Detected With Quantitation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 0016U. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 0016U fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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