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See a sample rate comparisonCPT 81243 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81243 |
| Medicaid Fee Schedule | View Medicaid rates for 81243 |
National average reimbursement for CPT 81243 by major payers:
$47.89
$34.98
$66.00
$108.54
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CPT 81243
5 of 25 sample ratesHigher to lower in this preview
Hind Al Saif
$281.70Published rateRegents Of The Univ Of Ca, Regents/Ucd Pbg/ Genetics
$198.66Published rateRenata Gallagher
$71.30Published rateGrace Kavanaugh
Tennessee Oncology PLLC
$51.34Published rateJaime Barea
Dnaforward PC
$23.95Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81243 vs. Other Molecular Pathology Procedures Codes
The CPT 81243 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 81243 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 |
|---|---|---|
| 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. |
| 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 |
| 81244-CPT | Low | Fmr1 Gen Alys Charac Alleles, Fmr1 Fragile X Messenger Ribonucleoprotein 1 Eg Fragile X Syndrome X Linked Intellectual Disability Xlid Gene Analysis Characterization Of Alleles Eg Expanded Size And Promoter Methylation Status |
| 81245-CPT | Low | Genetic Test For Leukemia, A Lab Analysis Of Genetic Material That Can Indicate Acute Myeloid Leukemia. 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 81243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81243 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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