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See a sample rate comparisonCPT 81216 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.
Brca2 Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Breast Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints.
| 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 59 - Distinct Procedural Service GW - Condition not related to the patient's terminal condition |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81216 |
| Medicaid Fee Schedule | View Medicaid rates for 81216 |
National average reimbursement for CPT 81216 by major payers:
$208.35
$113.60
$265.52
$292.39
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CPT 81216
5 of 25 sample ratesHigher to lower in this preview
Joselyn Gonzalez
Atlantic Health System Inc
$247.47Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$219.92Published rateChristopher Raio
St Joseph Hospital
$184.93Published rateMichael Shuler
Athens Orthopedic Clinic, P.A.
$111.07Published rateBrittany Ptachick
Hroa 401k Plan
$77.75Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81216 vs. Other Molecular Pathology Procedures Codes
The CPT 81216 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 81216 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 |
|---|---|---|
| 81212-CPT | Moderate | Brca1 2 185 5385 6174 Vrnt, Brca1 Brca1 Dna Repair Associated Brca2 Brca2 Dna Repair Associated Eg Hereditary Breast And Ovarian Cancer Gene Analysis 185delag 5385insc 6174delt Variants |
| 81215-CPT | Moderate | Brca1 Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Breast Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81216-CPT | Moderate | Brca2 Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Breast Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81217-CPT | Moderate | Brca2 Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Breast Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81216 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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