CPT 81233 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 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81233 |
| Medicaid Fee Schedule | View Medicaid rates for 81233 |
National average reimbursement for CPT 81233 by major payers:
$145.17
$107.60
$162.01
$262.23
CPT 81233 vs. Other Molecular Pathology Procedures Codes
The CPT 81233 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 81233 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 |
|---|---|---|
| 81233-CPT | Low | Genetic Test For Leukemia, A Lab Analysis Of Genetic Material That Can Indicate Chronic Lymphocytic Leukemia. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81235-CPT | Moderate | Genetic Test For Lung Cancer, A Lab Analysis Of Genetic Material That Can Indicate The Likelihood Of Developing Lung Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81236-CPT | Moderate | Ezh2 Gene Full Gene Sequence, Ezh2 Enhancer Of Zeste 2 Polycomb Repressive Complex 2 Subunit Eg Myelodysplastic Syndrome Myeloproliferative Neoplasms Gene Analysis Full Gene Sequence |
| 81238-CPT | Moderate | Clotting Problem Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate A Problem With Blood Clotting. 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 81233. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81233 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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