CPT 81106 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Pathology and Laboratory Procedures • Molecular Pathology Procedures |
| Common Place of Service | • 81 - Independent Laboratory • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 90 - Reference Laboratory • 91 - Repeat Lab Test |
| Complexity Level | Low |
National average reimbursement for CPT 81106 by major payers:
$125.29
$83.60
$121.80
$200.96
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 81106 | ||||||
United | 81106 | $63.36 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $63.36 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1821081720 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1033117007 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $60.36 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $111.26 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $60.36 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $60.36 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81106 | $268.88 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81106 | $51.33 | 1851464549 - PROGRESSIVE MEDICAL CENTER SC | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 81106 | $150.89 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 81106 | $145.20 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81106 vs. Other Molecular Pathology Procedures Codes
The CPT 81106 code is part of the Pathology and Laboratory Procedures services used for Molecular Pathology Procedures. 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 81106 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 |
|---|---|---|
| 81105-CPT | Low | Human Platelet Antigen 1 Genotyping (Hpa-1) Itgb3 (Integrin Beta 3 [Platelet Glycoprotein Iiia] Antigen Cd61 [Gpiiia]) (Eg Neonatal Alloimmune Thrombocytopenia [Nait] Post- Transfusion Purpura) Gene Analysis Common Variant Hpa-1a/B (L33p) |
| 81106-CPT | Low | Human Platelet Antigen 2 Genotyping (Hpa-2) Gp1ba (Glycoprotein Ib [Platelet] Alpha Polypeptide [Gpiba]) (Eg Neonatal Alloimmune Thrombocytopenia [Nait] Post-Transfusion Purpura) Gene Analysis Common Variant Hpa- 2a/B (T145m) |
| 81107-CPT | Low | Human Platelet Antigen 3 Genotyping (Hpa-3) Itga2b (Integrin Alpha 2b [Platelet Glycoprotein Iib Of Iib/Iiia Complex] Antigen Cd41 [Gpiib]) (Eg Neonatal Alloimmune Thrombocytopenia [Nait] Post-Transfusion Purpura) Gene Analysis Common Variant Hpa-3a/B (I843s) |
| 81108-CPT | Low | Human Platelet Antigen 4 Genotyping (Hpa-4) Itgb3 (Integrin Beta 3 [Platelet Glycoprotein Iiia] Antigen Cd61 [Gpiiia]) (Eg Neonatal Alloimmune Thrombocytopenia [Nait] Post- Transfusion Purpura) Gene Analysis Common Variant Hpa-4a/B (R143q) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81106. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81106 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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