CPT 81267 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 | Genetic Analysis Procedures Tier 1 Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service XE - Separate encounter |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81267 |
National average reimbursement for CPT 81267 by major payers:
$182.50
$148.59
$263.47
$322.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81267 | $124.48 | 1518028075 - SAEED BAJESTANI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anatomic Pathology Physician (207ZP0101X) |
United | 81267 | $105.80 | 1265942924 - ASHLEY MOSS | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 81267 | $124.48 | 1255657128 - JESSICA FRAKES | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Radiation Oncology Physician (2085R0001X) |
United | 81267 | $124.48 | 1780145219 - MATTHEW HECKROTH | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Internal Medicine Physician (207R00000X) |
United | 81267 | $124.48 | 1871148262 - JONGMYUNG KIM | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Radiation Oncology Physician (2085R0001X) |
United | 81267 | $124.48 | 1730596925 - JASKARAN SETHI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 81267 | $105.80 | 1427440544 - STEPHANIE BONVENTRE | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 81267 | $124.48 | 1225225865 - ASMITA MISHRA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Hematology & Oncology Physician (207RH0003X) |
United | 81267 | $124.48 | 1457642381 - SETH FELDER | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | NY | Surgery Physician (208600000X) |
United | 81267 | $124.48 | 1376599340 - JHANELLE GRAY | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Internal Medicine Physician (207R00000X) |
United | 81267 | $105.80 | 1962560888 - LINDA MARIE GARDNER | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Adult Health Nurse Practitioner (363LA2200X) |
United | 81267 | $209.86 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81267 | $124.48 | 1962422485 - LYNN MOSCINSKI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 81267 | $105.80 | 1992250575 - LESLIE COSENTINO | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Gerontology Nurse Practitioner (363LG0600X) |
United | 81267 | $105.80 | 1427321041 - MATTHEW WALLACE | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | MI | Medical Physician Assistant (363AM0700X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81267 vs. Other Tier 1 Molecular Pathology Procedures Codes
The CPT 81267 code is part of the Genetic Analysis Procedures services used for Tier 1 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 81267 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 |
| 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 |
| 81267-CPT | Low | Chimerism Anal No Cell Selec, Chimerism Engraftment Analysis Post Transplantation Specimen Eg Hematopoietic Stem Cell Includes Comparison To Previously Performed Baseline Analyses Without Cell Selection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81267. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81267 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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