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See a sample rate comparisonCPT 81261 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81261 |
| Medicaid Fee Schedule | View Medicaid rates for 81261 |
National average reimbursement for CPT 81261 by major payers:
$165.99
$141.99
$199.67
$308.65
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CPT 81261
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$435.58Published rateChristopher Raio
St Francis Hospital
$261.35Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$158.39Published rateSacred Heart Health System Inc, Sacred Heart Home Care
Sacred Heart Health System Inc
$114.06Published rateAaron Askew
The Orthopedic And Neurosurgical Center Of The Cascades
$83.16Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81261 vs. Other Molecular Pathology Procedures Codes
The CPT 81261 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 81261 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 |
|---|---|---|
| 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 |
| 81262-CPT | Low | Igh Gene Rearrang Dir Probe, Igh Immunoglobulin Heavy Chain Locus Eg Leukemias And Lymphomas B Cell Gene Rearrangement Analysis To Detect Abnormal Clonal Population S Direct Probe Methodology Eg Southern Blot |
| 81263-CPT | Moderate | Igh@ (Immunoglobulin Kappa Light Chain Locus) (Eg, Leukemia And Lymphoma, B-Cell), Gene Rearrangement Analysis, Evaluation To Detect Abnormal Clonal Population(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81261 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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