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See a sample rate comparisonCPT 81257 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.
Hba/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syn- Drome Hbh Disease) Gene Analysis Common Deletions Or Variant (Eg Southeast Asian Thai Filipino Mediterranean Alpha3.7 Alpha4.2 Alpha20.5 And Constant Spring) (Desc Revised 1/1/2018)
| 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 XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81257 |
| Medicaid Fee Schedule | View Medicaid rates for 81257 |
National average reimbursement for CPT 81257 by major payers:
$88.59
$62.69
$106.97
$173.17
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CPT 81257
5 of 25 sample ratesHigher to lower in this preview
Athena Angelopoulos
$561.15Published rateJoseph Shieh
$505.04Published ratePatricia Aoun
City Of Hope Medical Foundation
$296.79Published rateWest Jefferson Holdings, LLC, West Jefferson Medical Center
West Jefferson Holdings, LLC
$92.02Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Health Arklatex
$42.95Published rate
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See a sample payer proposalCPT 81257 vs. Other Molecular Pathology Procedures Codes
The CPT 81257 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 81257 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 |
|---|---|---|
| 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. |
| 81257-CPT | Low | Hba/Hba2 (Alpha Globin 1 And Alpha Globin 2) (Eg Alpha Thalassemia Hb Bart Hydrops Fetalis Syn- Drome Hbh Disease) Gene Analysis Common Deletions Or Variant (Eg Southeast Asian Thai Filipino Mediterranean Alpha3.7 Alpha4.2 Alpha20.5 And Constant Spring) (Desc Revised 1/1/2018) |
| 81258-CPT | Moderate | Hba1hba2 (Alpha Globin 1 And, Hba1hba2 (Alpha Globin 1 And Alpha Globin 2) (Egalpha Thalassemia Hb Bart Hydrops Fetalis Syndro Me Hbh Disease) Gene Analysis Known Familial Variant (Eg Exon 12) Hpa-9ab (V837m) |
| 81259-CPT | Moderate | Hba1hba2 (Alpha Globin 1 And, Hba1hba2 (Alpha Globin 1 And Alpha Globin 2) (Egalpha Thalassemia Hb Bart Hydrops Fetalis Syndro Me Hbh Disease) Gene Analysis Full Gene Sequence (Eg Exon 12) Hpa-9ab (V837m) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81257. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81257 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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