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See a sample rate comparisonCPT 81191 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.
Ighbcl2 (T(1418)) (Eg Foll, Ighbcl2 (T(1418)) (Eg Follicular Lymphoma) Translocation Analysis Major Breakpoint Region (Mbr)And Minor Cluster Region (Mcr) Breakpoints Quali Tative Or Quantitative
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81191 |
| Medicaid Fee Schedule | View Medicaid rates for 81191 |
National average reimbursement for CPT 81191 by major payers:
$188.44
$128.54
$192.45
$310.01
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CPT 81191
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$456.08Published rateChristopher Raio
St Joseph Hospital
$246.28Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$207.31Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$152.88Published rateRenal Consultants Medical Group
$87.06Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81191 vs. Other Molecular Pathology Procedures Codes
The CPT 81191 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 81191 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 |
|---|---|---|
| 81191-CPT | Low | Ighbcl2 (T(1418)) (Eg Foll, Ighbcl2 (T(1418)) (Eg Follicular Lymphoma) Translocation Analysis Major Breakpoint Region (Mbr)And Minor Cluster Region (Mcr) Breakpoints Quali Tative Or Quantitative |
| 81192-CPT | Low | Jak2 (Janus Kinase 2) (Eg Mye, Jak2 (Janus Kinase 2) (Eg Myeloproliferative Disorder) Targeted Sequence Analysis (Eg Exons 12 And13) |
| 81193-CPT | Low | Mpl (Mpl Proto-Oncogene Throm, Mpl (Mpl Proto-Oncogene Thrombopoietin Receptor) (Eg Myeloproliferative Disorder) Gene Analysis Common Variants (Eg W515a W515k W515l W515r) |
| 81194-CPT | Moderate | Ntrk (Neurotrophic-Tropomyosin Receptr Tyrosine..., Ntrk (Neurotrophic-Tropomyosin Receptor Tyrosine Kinase 1 2 And 3) (Eg Solid Tumors) Translocation Analysis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81191. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81191 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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