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See a sample rate comparisonCPT 81225 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 Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects.
| 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 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81225 |
| Medicaid Fee Schedule | View Medicaid rates for 81225 |
National average reimbursement for CPT 81225 by major payers:
$222.37
$178.68
$265.25
$435.36
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CPT 81225
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$640.99Published rateAaron Askew
Praxis Health, P.C.
$320.50Published rateAsya Segalene
Allergy & Asthma Of Dupage, S.C.
$291.80Published rateMichael Shuler
Athens Orthopedic Clinic, PA
$174.82Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$116.72Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81225 vs. Other Molecular Pathology Procedures Codes
The CPT 81225 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 81225 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 |
|---|---|---|
| 81224-CPT | Low | Cystic Fibrosis Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Cystic Fibrosis. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81225-CPT | Moderate | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
| 81226-CPT | Moderate | Cyp2d6 Gene Com Variants, Cyp2d6 Cytochrome P450 Family 2 Subfamily D Polypeptide 6 Eg Drug Metabolism Gene Analysis Common Variants Eg 2 3 4 5 6 9 10 17 19 29 35 41 1xn 2xn 4xn |
| 81227-CPT | Low | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81225. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81225 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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