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See a sample rate comparisonCPT 81239 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.
Myotonic Dystrophy Gene Test, A Lab Analysis Of Genetic Material That Can Indicate Myotonic Dystrophy A Form Of Muscular Dystrophy Accompanied By Myotonia The Inability To Relax A Muscle.
| 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 81239 |
| Medicaid Fee Schedule | View Medicaid rates for 81239 |
National average reimbursement for CPT 81239 by major payers:
$213.87
$168.46
$254.43
$397.58
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CPT 81239
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$604.63Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$274.83Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$202.66Published rateRolando Henriquez
Progressive Medical Center, S.C.
$151.16Published 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
$96.19Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81239 vs. Other Molecular Pathology Procedures Codes
The CPT 81239 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 81239 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 |
|---|---|---|
| 81234-CPT | Low | Myotonic Dystrophy Gene Test, A Lab Analysis Of Genetic Material That Can Indicate Myotonic Dystrophy A Form Of Muscular Dystrophy Accompanied By Myotonia The Inability To Relax A Muscle. |
| 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 |
| 81239-CPT | Moderate | Myotonic Dystrophy Gene Test, A Lab Analysis Of Genetic Material That Can Indicate Myotonic Dystrophy A Form Of Muscular Dystrophy Accompanied By Myotonia The Inability To Relax A Muscle. |
| 81242-CPT | Low | Fanconi Anemia Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Anemia. 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 81239. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81239 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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