CPT 81240 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 • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 81240 by major payers:
$51.91
$40.66
$64.69
$126.30
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 81240 | ||||||
United | 81240 | $67.43 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81240 | $65.69 | 1841843455 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE EMERGENCY ROOM MONTWOOD | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 81240 | $161.80 | 1710979935 - ROBERT DAUL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | 81240 | $52.55 | 1255766531 - MARISSA LIVERIS | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Physician Assistant (363A00000X) |
United | 81240 | $161.80 | 1801401252 - JODI TESCH | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | 81240 | $65.69 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81240 | $65.69 | 1548232044 - LAREDO TEXAS HOSPITAL COMPANY LP, LAREDO MEDICAL CENTER | 200175530 | TX | General Acute Care Hospital (282N00000X) |
United | 81240 | $27.59 | 1487771705 - DONNA MEDICAL CLONIC | 223875437 - (TX) DONNA MEDICAL CLINIC, P.A. | TX | General Acute Care Hospital (282N00000X) |
United | 81240 | $144.52 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81240 | $161.80 | 1093820219 - KIMBERLY KARRMANN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | 81240 | $65.69 | 1437102639 - COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP, MEDICAL CITY MCKINNEY | 621682207 - (TX) COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 81240 | $161.80 | 1902030380 - KRISTEN MUSSER | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | 81240 | $67.43 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 81240 | $27.59 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 81240 | $144.52 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 81240 vs. Other Molecular Pathology Procedures Codes
The CPT 81240 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 81240 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 |
|---|---|---|
| 81235-CPT | Moderate | Egfr (Epidermal Growth Factor Receptor) (Eg, Non-Small Cell Lung Cancer) Gene Analysis, Common Variants (Eg, Exon 19 Lrea Deletion, L858r, T790m, G719a, G719s, L861q) |
| 81236-CPT | Moderate | Ezh2 (Enhancer Of Zeste 2 Polycomb Repressive Com-Plex Subunit) (Eg Myelodysplastic Syndrome Myeloproliferative Neoplasms) Gene Analysis Full Gene Sequence |
| 81237-CPT | Low | Ezh2 (Enhancer Of Zeste 2 Polycomb Repressive Complex 2 Subunit) (Eg Diffuse Large B-Cell Lymphoma) Gene Analysis Common Variant(S) (Eg Codon 646) |
| 81240-CPT | Low | F2 (Prothrombin Coagulation Factor Ii) (Eg Hereditary Hypercoagulability) Gene Analysis 20210g>A Variant |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81240 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 81240) and we'll show you how you compare in 15 minutes or less.