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See a sample rate comparisonCPT 81209 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.
Blm (Bloom Syndro Recq Helicas-Like) (Eg Bloom Syndro) Gene Ana, Blm (Bloom Syndrome Recq Helicase-Like) (Eg Bloom Syndrome) Gene Ana
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81209 |
| Medicaid Fee Schedule | View Medicaid rates for 81209 |
National average reimbursement for CPT 81209 by major payers:
$37.20
$24.09
$41.86
$86.25
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CPT 81209
5 of 25 sample ratesHigher to lower in this preview
Overlook Hospital, Atlantic Health Systems
Atlantic Health System Inc
$52.54Published rateChristopher Raio
Mercy Medical Center
$39.27Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$28.98Published rateMichael Jacobson
Hroa 401k Plan
$16.51Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$13.76Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81209 vs. Other Molecular Pathology Procedures Codes
The CPT 81209 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 81209 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 |
|---|---|---|
| 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 |
| 81209-CPT | Low | Blm (Bloom Syndro Recq Helicas-Like) (Eg Bloom Syndro) Gene Ana, Blm (Bloom Syndrome Recq Helicase-Like) (Eg Bloom Syndrome) Gene Ana |
| 81210-CPT | Low | Braf (B-Raf Proto-Oncogene Se, Braf (B-Raf Proto-Oncogene Serinethreonine Kinase) (Eg Colon Cancer Melanoma) Gene Analysis V600 Variant(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81209. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81209 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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