CPT 81161 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 • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 81161 by major payers:
$204.72
$134.03
$303.91
$436.08
| 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 81161 | ||||||
United | 81161 | $84.08 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 81161 | $1531.04 | 1598113904 - ALICIA ORTA | 943281657 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81161 | $279.00 | 1215121132 - OPHIR KLEIN | 943191703 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81161 | $813.05 | 1750834677 - MONICA STAMP | 475502470 - (CA) REGENTS OF THE UNIVERSITY OF CALIFORNIA | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81161 | $279.00 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $251.10 | 1740910330 - BRENDEN PHUNG | 621647259 - TENNESSEE ONCOLOGY PLLC | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81161 | $57.50 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $279.00 | 1669752234 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $62.38 | 1356320873 - EAST TEXAS MEDICAL CENTER ATHENS | 751854562 - (TX) ETX SUCCESSOR ATHENS | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $279.00 | 1477516466 - SCOTT & WHITE MEMORIAL HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TEMPLE | 741166904 - SCOTT & WHITE MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $292.95 | 1831403211 - HIND AL SAIF | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81161 | $279.00 | 1841237807 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $168.16 | 1225289499 - LUBBOCK HERITAGE HOSPITAL, LLC., GRACE SURGICAL HOSPITAL | 264021016 - (TX) LUBBOCK HERITAGE HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $279.00 | 1003344334 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE HORIZON CITY CAMPUS | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 81161 | $279.00 | 1093793408 - JACKSON PARISH HOSPITAL, JACKSON PARISH HOSPITAL | 720549907 | LA | Critical Access Hospital (282NC0060X) |
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 81161 vs. Other Molecular Pathology Procedures Codes
The CPT 81161 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 81161 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) |
| 81120-CPT | Low | Idh1 (Isocitrate Dehydrogenase 1 [Nadp+] Soluble) (Eg Glioma) Common Variants (Eg R132h R132c) |
| 81121-CPT | Moderate | Idh2 (Isocitrate Dehydrogenase 2 [Nadp+] Mitochondrial) (Eg Glioma) Common Variants (Eg R140w R172m) |
| 81161-CPT | Moderate | Dmd (Dystrophin) (Eg, Duchenne/Becker Muscular Dystrophy) Deletion Analysis, And Duplication Analysis, If Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81161. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81161 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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