CPT 81200 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 | Genetic Analysis Procedures Tier 1 Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81200 |
National average reimbursement for CPT 81200 by major payers:
$44.45
$28.96
$56.63
$94.73
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81200 | $192.63 | 1831683242 - MARINA DUTRA-CLARKE | 954377219 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81200 | $47.25 | 1598113904 - ALICIA ORTA | 943281657 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81200 | $47.25 | 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 | 81200 | $233.36 | 1245490481 - SARAH RUSSELL | 943281660 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81200 | $23.44 | 1396014866 - KATHRYN SINGH | 271504911 - (CA) MEMORIALCARE MEDICAL FOUNDATION | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81200 | $159.89 | 1932343316 - KEVIN MCDONNELL | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81200 | $259.29 | 1518719806 - SOGHRA JOUGHEH DOUST | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81200 | $72.29 | 1952424079 - CATHERINE KARIMOV | 953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81200 | $19.85 | 1902930381 - SANTA CLARA CO IPA | 473490581 - (CA) BAY AREA ACCOUNTABLE CARE NETWORK | CA | Ph.D. Medical Genetics (170100000X) |
United | 81200 | $47.25 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 81200 | $72.29 | 1164541181 - MATTHEW DEARDORFF | 953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81200 | $233.36 | 1144208463 - NICOLA CADENAS | 943281662 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81200 | $47.25 | 1669483590 - METHUSA MEJIA | 593765949 - (CA) PALM DESERT PEDIATRICS, INC. | CA | Ph.D. Medical Genetics (170100000X) |
United | 81200 | $19.85 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 81200 | $259.29 | 1033464821 - JESSICA TENNEY | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
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 81200 vs. Other Tier 1 Molecular Pathology Procedures Codes
The CPT 81200 code is part of the Genetic Analysis Procedures services used for Tier 1 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 81200 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 |
|---|---|---|
| 81182-CPT | Low | Genetic Test For Sca, A Lab Analysis Of Genetic Material That Can Indicate Sca (Spinocerebellar Ataxia) A Disorder Characterized By Progressive Incoordination Of Gait And Is Often Associated With Poor Coordination Of Hands Speech And Eye Movements. |
| 81183-CPT | Low | Genetic Test For Sca, A Lab Analysis Of Genetic Material That Can Indicate Sca (Spinocerebellar Ataxia) A Disorder Characterized By Progressive Incoordination Of Gait And Is Often Associated With Poor Coordination Of Hands Speech And Eye Movements. |
| 81200-CPT | Low | Aspa (Aspartoacylase) (Eg Canavan Diseas) Gene Analy Common Vari, Aspa (Aspartoacylase) (Eg Canavan Disease) Gene Analysis Common Vari |
| 81201-CPT | Moderate | Genetic Test For Fap, A Lab Analysis Of Genetic Material That Can Indicate The Likelihood Of Developing Polyps Followed By Colon Cancer. This Is A Condition Called Fap (Familial Adenomatous Polyposis). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81200 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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