Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 81260 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81260 |
| Medicaid Fee Schedule | View Medicaid rates for 81260 |
National average reimbursement for CPT 81260 by major payers:
$37.62
$24.09
$45.63
$86.30
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 81260.
CPT 81260
5 of 25 sample ratesHigher to lower in this preview
Barry Tong
$215.72Published rateLaurel Hochstetler
$194.13Published rateStacy Gray
City Of Hope Medical Foundation
$133.02Published rateCovenant Medical Center
$47.16Published rateEl Campo Memorial Hospital
$16.51Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 81260 vs. Other Molecular Pathology Procedures Codes
The CPT 81260 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 81260 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 |
|---|---|---|
| 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) |
| 81261-CPT | Low | Igh Gene Rearrange Amp Meth, Igh Immunoglobulin Heavy Chain Locus Eg Leukemias And Lymphomas B Cell Gene Rearrangement Analysis To Detect Abnormal Clonal Population S Amplified Methodology Eg Polymerase Chain Reaction |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81260. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81260 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 81260) and we'll show you how you compare in 15 minutes or less.