CPT 81256 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 |
| Medicare Fee Schedule | View Medicare rates for 81256 |
National average reimbursement for CPT 81256 by major payers:
$56.67
$46.81
$72.72
$127.29
| 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 81256 | ||||||
United | 81256 | $65.36 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $89.16 | 1932729803 - DALLAS VAMC | 756108647 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $78.43 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $37.45 | 1649224825 - JONES COUNTY REGIONAL HEALTHCARE SYSTEM, STAMFORD MEMORIAL HOSPITAL | 461285811 - (TX) JONES COUNTY REGIONAL HEALTHCARE SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1871137513 - CANYON ATLANTIC | 843385649 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $80.25 | 1689676835 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1679528889 - ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, ST. DAVID'S SOUTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1295723229 - ST FRANCIS MEDICAL CENTER, INC | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 81256 | $58.81 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1679528889 - ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, ST. DAVID'S SOUTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1093744187 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1457994188 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MICRO-HOSPITAL WESLACO | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1093793408 - JACKSON PARISH HOSPITAL, JACKSON PARISH HOSPITAL | 720549907 | LA | Critical Access Hospital (282NC0060X) |
United | 81256 | $78.43 | 1174526529 - TITUS COUNTY HOSPITAL DISTRICT, TITUS REGIONAL MEDICAL CENTER | 756003935 | TX | General Acute Care Hospital (282N00000X) |
United | 81256 | $65.36 | 1447230388 - OPELOUSAS GENERAL HOSPITAL AUTHORITY | 720708111 | LA | General Acute Care Hospital (282N00000X) |
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 |
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CPT 81256 vs. Other Molecular Pathology Procedures Codes
The CPT 81256 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 81256 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 |
|---|---|---|
| 81251-CPT | Low | Gba (Glucosidase, Beta, Acid) (Eg, Gaucher Disease) Gene Analysis, Common Variants (Eg, N370s, 84gg, L444p, Ivs2+1g>A) |
| 81255-CPT | Low | Hexa (Hexosaminidase A [Alpha Polypeptide]) (Eg, Tay-Sachs Disease) Gene Analysis, Common Variants (Eg, 1278instatc, 1421+1g>C, G269s) |
| 81256-CPT | Low | Hfe (Hemochromatosis) (Eg, Hereditary Hemochromatosis) Gene Analysis, Common Variants (Eg, C282y, H63d) |
| 81256-CPT | Low | Hfe (Hemochromatosis) (Eg, Hereditary Hemochromatosis) Gene Analysis, Common Variants (Eg, C282y, H63d) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81256. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81256 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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