Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 81168 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.
Ccnd1/Igh Translocation Alys Major Breakpoint..., Ccnd1/Igh (T(11;14)) (Eg Mantle Cell Lymphoma) Translocation Analysis Major Breakpoint Qualitative And Quantitative If P
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None XE - Separate encounter 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81168 |
| Medicaid Fee Schedule | View Medicaid rates for 81168 |
National average reimbursement for CPT 81168 by major payers:
$188.18
$128.53
$190.33
$321.43
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 81168.
CPT 81168
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$456.08Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$246.28Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$207.31Published rateMichael Shuler
Athens Orthopedic Clinic, P.A.
$124.39Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$72.55Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 81168 vs. Other Molecular Pathology Procedures Codes
The CPT 81168 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 81168 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 |
|---|---|---|
| 81106-CPT | Low | Human Platelet Antigen 2 Genot, Human Platelet Antigen 2 Genotyping (Hpa-2) Gp1ba(Glycoprotein Ib [Platelet] Alpha Polypeptide [G Piba]) (Eg Neonatal Alloimmune Thrombocytopenia [Nait] Post-Transfusion Purpura) Gene Analysis Common Variant Hpa-2ab (T145m) Pharyngogastrostomy Or Esophagogastrostomy (Ie Th |
| 81168-CPT | Low | Ccnd1/Igh Translocation Alys Major Breakpoint..., Ccnd1/Igh (T(11;14)) (Eg Mantle Cell Lymphoma) Translocation Analysis Major Breakpoint Qualitative And Quantitative If P |
| 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. |
| 81171-CPT | Low | Aff2 Gen Aly Detc Abnl Allel, Aff2 Alf Transcription Elongation Factor 2 Fmr2 Eg Fragile X Intellectual Disability 2 Fraxe Gene Analysis Evaluation To Detect Abnormal Eg Expanded Alleles |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81168. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81168 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 81168) and we'll show you how you compare in 15 minutes or less.