CPT 81205 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 | Pathology and Laboratory Procedures 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 81205 |
| Medicaid Fee Schedule | View Medicaid rates for 81205 |
National average reimbursement for CPT 81205 by major payers:
$81.27
$58.19
$95.41
$162.66
CPT 81205 vs. Other Molecular Pathology Procedures Codes
The CPT 81205 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 81205 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 |
|---|---|---|
| 81205-CPT | Low | Bckdhb (Branched-Chain Keto Ac, Bckdhb (Branched-Chain Keto Acid Dehydrogenase E1beta Polypeptide) (Eg Maple Syrup Urine Disease) Gene Analysis Common Variants (Eg R183p G278s E422x) |
| 81206-CPT | Low | Bcrabl1 (T(922)) (Eg Chroni, Bcrabl1 (T(922)) (Eg Chronic Myelogenous Leukemia) Translocation Analysis Major Breakpoint Qualitative Or Quantitative |
| 81207-CPT | Low | Bcrabl1 (T(922)) (Eg Chroni, Bcrabl1 (T(922)) (Eg Chronic Myelogenous Leukemia) Translocation Analysis Minor Breakpoint Qualitative Or Quantitative |
| 81208-CPT | Low | Bcrabl1 (T(922)) (Eg Chroni, Bcrabl1 (T(922)) (Eg Chronic Myelogenous Leukemia) Translocation Analysis Other Breakpoint Qualitative Or Quantitative |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81205 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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