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See a sample rate comparisonCPT 81255 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.
Tay-Sachs Disease Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Tay-Sachs Disease. 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 |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81255 |
| Medicaid Fee Schedule | View Medicaid rates for 81255 |
National average reimbursement for CPT 81255 by major payers:
$47.64
$31.53
$67.54
$100.95
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CPT 81255
5 of 25 sample ratesHigher to lower in this preview
Sarah Sturm
$254.10Published rateJoanne Jeter
City Of Hope Medical Foundation
$174.11Published rateTina Cowan
$83.43Published rateNikki Madson
$51.45Published rateChca Bayshore Lp, Bayshore Medical Center
$21.61Published rate
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See a sample payer proposalCPT 81255 vs. Other Molecular Pathology Procedures Codes
The CPT 81255 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 81255 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 |
|---|---|---|
| 81252-CPT | Low | Genetic Test For Hearing Loss, A Lab Analysis Of Genetic Material That Can Indicate The Likelihood Of Developing Hearing Loss. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81253-CPT | Low | Genetic Test For Hearing Loss, A Lab Analysis Of Genetic Material That Can Indicate The Likelihood Of Developing Hearing Loss. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81255-CPT | Low | Tay-Sachs Disease Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate Tay-Sachs Disease. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81256-CPT | Low | Iron Condition Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate A Problem With Too Much Iron (Hemochromatosis). 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 81255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81255 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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