Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 81227 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 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81227 |
| Medicaid Fee Schedule | View Medicaid rates for 81227 |
National average reimbursement for CPT 81227 by major payers:
$135.66
$107.44
$165.68
$271.92
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 81227.
CPT 81227
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$384.58Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$175.85Published rateAnn Steck
$104.89Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$87.54Published rateDermatology And Skin Cancer Surgery Center, LLC, Orlando Dermatology Center
Dermatology And Skin Cancer Surgery Center LLC
$73.41Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 81227 vs. Other Molecular Pathology Procedures Codes
The CPT 81227 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 81227 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 |
|---|---|---|
| 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. |
| 81228-CPT | Moderate | Cytogenomic Constitutional (Genome-Wide) Microarray Analysis; Interrogation Of Genomic Regions For Copy Number Variants (Eg, Bacterial Artificial Chromosome (Bac) Or Oligo-Based Comparative Genomic Hybridization (Cgh) Microarray Analysis) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81227. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81227 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 81227) and we'll show you how you compare in 15 minutes or less.