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See a sample rate comparisonCPT 81263 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@ (Immunoglobulin Kappa Light Chain Locus) (Eg, Leukemia And Lymphoma, B-Cell), Gene Rearrangement Analysis, Evaluation To Detect Abnormal Clonal Population(S)
| 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 XU - Unusual Non-Overlapping Service 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81263 |
| Medicaid Fee Schedule | View Medicaid rates for 81263 |
National average reimbursement for CPT 81263 by major payers:
$242.41
$210.93
$279.51
$447.20
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CPT 81263
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$647.94Published rateAshley O'Connor
Atlantic Health System Inc
$328.10Published rateNicole Schwab
Allergy & Asthma Of Dupage, S.C.
$235.62Published rateNevada Eye Care Professionals Little & Stein, Ltd.
Nevada Eye Care Professionals
$168.75Published rateRolando Henriquez
Progressive Medical Center, S.C.
$123.69Published rate
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See a sample payer proposalCPT 81263 vs. Other Molecular Pathology Procedures Codes
The CPT 81263 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 81263 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 |
|---|---|---|
| 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 |
| 81265-CPT | Low | Str Markers Specimen Anal, Comparative Analysis Using Short Tandem Repeat Str Markers Patient And Comparative Specimen Eg Pre Transplant Recipient And Donor Germline Testing Post Transplant Non Hematopoietic Recipient Germline Eg Buccal Swab Or Other Germline Tissue Sample And Donor Testing Twin Zygosity Testing Or Maternal Cell Contamination Of Fetal Cells |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81263 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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