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See a sample rate comparisonCPT 81242 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81242 |
| Medicaid Fee Schedule | View Medicaid rates for 81242 |
National average reimbursement for CPT 81242 by major payers:
$35.77
$22.44
$41.70
$82.36
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CPT 81242
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$80.56Published rateAaron Askew
Praxis Health, P.C.
$40.28Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$27.01Published rateChristopher Raio
St Joseph Hospital
$19.77Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$14.64Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81242 vs. Other Molecular Pathology Procedures Codes
The CPT 81242 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 81242 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. |
| 81241-CPT | Low | 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. |
| 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. |
| 81243-CPT | Low | Fmr1 Gen Aly Detc Abnl Allel, Fmr1 Fragile X Messenger Ribonucleoprotein 1 Eg Fragile X Syndrome X Linked Intellectual Disability Xlid Gene Analysis Evaluation To Detect Abnormal Eg Expanded Alleles |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81242 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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