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See a sample rate comparisonCPT 81259 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None XU - Unusual Non-Overlapping Service 90 - Reference Laboratory |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81259 |
| Medicaid Fee Schedule | View Medicaid rates for 81259 |
National average reimbursement for CPT 81259 by major payers:
$451.93
$367.74
$549.43
$841.80
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CPT 81259
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,320.00Published rateChristopher Raio
Mercy Medical Center
$712.80Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$442.45Published rateHans Henriquez
Progressive Medical Center, S.C.
$330.00Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$240.00Published rate
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See a sample payer proposalCPT 81259 vs. Other Molecular Pathology Procedures Codes
The CPT 81259 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 81259 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 |
|---|---|---|
| 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) |
| 81260-CPT | Low | Ikbkap (Inhibitor Of Kappa Lig, Ikbkap (Inhibitor Of Kappa Light Polypeptide Gene Enhancer In B-Cells Kinase Complex-Associated Protein) (Eg Familial Dysautonomia) Gene Analysis Common Variants (Eg 25076tc R696p) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81259 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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