CPT 81262 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 | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81262 |
| Medicaid Fee Schedule | View Medicaid rates for 81262 |
National average reimbursement for CPT 81262 by major payers:
$54.98
$39.59
$64.29
$123.55
CPT 81262 vs. Other Molecular Pathology Procedures Codes
The CPT 81262 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 81262 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 |
|---|---|---|
| 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) |
| 81264-CPT | Low | Igk Rearrangeabn Clonal Pop, Igk 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 81262. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81262 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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