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See a sample rate comparisonCPT 81163 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.
Brca1 2 Gene Full Seq Alys, Brca1 Brca1 Dna Repair Associated Brca2 Brca2 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis Full Sequence Analysis
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None XU - Unusual Non-Overlapping Service 90 - Reference Laboratory |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81163 |
| Medicaid Fee Schedule | View Medicaid rates for 81163 |
National average reimbursement for CPT 81163 by major payers:
$450.50
$286.90
$488.12
$675.22
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CPT 81163
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,029.60Published rateChristopher Raio
St Francis Hospital
$555.98Published rateMarissa Liveris
Allergy & Asthma Of Dupage, S.C.
$374.40Published rateCatherine Lee
Columbus Arthritis Center
$280.80Published rateAnant Desai
Renal Consultants Medical Group
$196.55Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81163 vs. Other Molecular Pathology Procedures Codes
The CPT 81163 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 81163 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 |
|---|---|---|
| 81162-CPT | High | Brca1 2 Gen Full Seq Dup Del, Brca1 Brca1 Dna Repair Associated Brca2 Brca2 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis Full Sequence Analysis And Full Duplication Deletion Analysis Ie Detection Of Large Gene Rearrangements |
| 81163-CPT | Moderate | Brca1 2 Gene Full Seq Alys, Brca1 Brca1 Dna Repair Associated Brca2 Brca2 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis Full Sequence Analysis |
| 81164-CPT | Moderate | Brca1 2 Gen Ful Dup Del Alys, Brca1 Brca1 Dna Repair Associated Brca2 Brca2 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis Full Duplication Deletion Analysis Ie Detection Of Large Gene Rearrangements |
| 81166-CPT | Moderate | Brca1 Gene Full Dup Del Alys, Brca1 Brca1 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis Full Duplication Deletion Analysis Ie Detection Of Large Gene Rearrangements |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81163. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81163 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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