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See a sample rate comparisonCPT 81161 Fee Schedule
Last Verified: September 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.
Test For Muscular Dystrophy, This Test Checks For Mutations Of The Dmd Gene Which Affects Production Of The Protein Dystrophin. When Mutations Are Present This Can Cause Duchenne/Becker Muscular Dystrophy A Progressive Condition Affecting Muscles.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 81161 |
| Medicaid Fee Schedule | View Medicaid rates for 81161 |
National average reimbursement for CPT 81161 by major payers:
$204.72
$134.03
$303.91
$419.70
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CPT 81161
5 of 25 sample ratesHigher to lower in this preview
Joyce So
$1,531.04Published rateDeborah Krakow
$1,292.55Published rateMatthew Deardorff
Childrens Hospital Los Angeles Medical Group Inc
$426.86Published rateEric Muller
$279.00Published rateEast Texas Medical Center Athens
Etx Successor Athens
$62.38Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 81120-CPT | Low | Idh1 (Isocitrate Dehydrogenase, Idh1 (Isocitrate Dehydrogenase 1 [Nadp] Soluble)(Eg Glioma) Common Variants (Eg R132h R132c) Ransfusion Purpura) Gene Analysis Common Variant Hpa-9ab (V837m) |
| 81121-CPT | Moderate | Idh2 (Isocitrate Dehydrogenase, Idh2 (Isocitrate Dehydrogenase 2 [Nadp] Mitochondrial) (Eg Glioma) Common Variants (Eg R140w R172m) Ransfusion Purpura) Gene Analysis Common Variant Hpa-9ab (V837m) |
| 81161-CPT | Moderate | Test For Muscular Dystrophy, This Test Checks For Mutations Of The Dmd Gene Which Affects Production Of The Protein Dystrophin. When Mutations Are Present This Can Cause Duchenne/Becker Muscular Dystrophy A Progressive Condition Affecting Muscles. |
| 81170-CPT | Moderate | Abl1(Abl Proto-Oncogene 1 Non Recptor Tyrosine Kinase), Abl1(Abl Proto-Oncogene 1 Non Receptor Tyrosine Kinase) (Eg. Aquired Imatinib Tyrosine Kinase Inhibitor Resistance) Gene Analysis Variants In The Kinase Domain. |
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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