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See a sample rate comparisonCPT 81201 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.
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).
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81201 |
| Medicaid Fee Schedule | View Medicaid rates for 81201 |
National average reimbursement for CPT 81201 by major payers:
$685.17
$477.50
$756.41
$1,097.56
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CPT 81201
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,716.00Published rateChristopher Raio
St Joseph Hospital
$926.64Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$780.00Published rateRolando Henriquez
Progressive Medical Center, S.C.
$429.00Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$312.00Published rate
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See a sample payer proposalCPT 81201 vs. Other Molecular Pathology Procedures Codes
The CPT 81201 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 81201 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 |
|---|---|---|
| 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). |
| 81202-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). |
| 81203-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 81201. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81201 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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