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See a sample rate comparisonCPT 81265 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81265 |
| Medicaid Fee Schedule | View Medicaid rates for 81265 |
National average reimbursement for CPT 81265 by major payers:
$191.78
$159.73
$262.49
$356.61
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CPT 81265
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$512.75Published rateChristopher Raio
St Joseph Hospital
$276.89Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$217.53Published rateMolly Mcintosh
Baycare Medical Group Inc
$123.90Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$81.56Published rate
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See a sample payer proposalCPT 81265 vs. Other Molecular Pathology Procedures Codes
The CPT 81265 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 81265 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 |
|---|---|---|
| 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 |
| 81266-CPT | Moderate | Str Markers Spec Anal Addl, Comparative Analysis Using Short Tandem Repeat Str Markers Each Additional Specimen Eg Additional Cord Blood Donor Additional Fetal Samples From Different Cultures Or Additional Zygosity In Multiple Birth Pregnancies List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81265 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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