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See a sample rate comparisonCPT 81204 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.
Ar (Androgen Receptor) (Eg Sp, Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Gene Analysis Characterization Of Alleles(Eg Expanded Size Or Methylation Status)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None 90 - Reference Laboratory GA - Required ABN issued and on file |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81204 |
| Medicaid Fee Schedule | View Medicaid rates for 81204 |
National average reimbursement for CPT 81204 by major payers:
$112.31
$83.98
$128.80
$221.00
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CPT 81204
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$301.40Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$137.00Published rateMichael Shuler
Athens Orthopedic Clinic, P.A.
$82.20Published rateCharleston Radiologists PA
Charleston Radiologists, P.A.
$68.50Published ratePatrick Reidy
Florida Gulf Coast Ear, Nose And Throat, LLC
$47.95Published rate
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See a sample payer proposalCPT 81204 vs. Other Molecular Pathology Procedures Codes
The CPT 81204 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 81204 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 |
|---|---|---|
| 81173-CPT | Moderate | Genetic Test Muscle Atrophy, A Lab Analysis Of Genetic Material That Can Indicate Muscle Degeneration. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81174-CPT | Low | Genetic Test Muscle Atrophy, A Lab Analysis Of Genetic Material That Can Indicate Muscle Degeneration. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 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). |
| 81204-CPT | Low | Ar (Androgen Receptor) (Eg Sp, Ar (Androgen Receptor) (Eg Spinal And Bulbar Muscular Atrophy Kennedy Disease X Chromosome Inactivation) Gene Analysis Characterization Of Alleles(Eg Expanded Size Or Methylation Status) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81204 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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