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See a sample rate comparisonCPT 81235 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 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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary 90 - Reference Laboratory |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81235 |
| Medicaid Fee Schedule | View Medicaid rates for 81235 |
National average reimbursement for CPT 81235 by major payers:
$311.18
$200.34
$310.82
$475.17
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CPT 81235
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$714.08Published rateAaron Askew
Praxis Health, P.C.
$357.04Published rateChristopher Raio
St Joseph Hospital
$194.75Published rateChristopher Raio
St Joseph Hospital
$175.27Published 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
$113.59Published rate
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See a sample payer proposalCPT 81235 vs. Other Molecular Pathology Procedures Codes
The CPT 81235 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 81235 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 |
|---|---|---|
| 81230-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. |
| 81231-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. |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81235 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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