CPT 81268 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 | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 91 - Repeat Lab Test |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81268 |
| Medicaid Fee Schedule | View Medicaid rates for 81268 |
National average reimbursement for CPT 81268 by major payers:
$224.35
$186.78
$268.61
$399.28
CPT 81268 vs. Other Molecular Pathology Procedures Codes
The CPT 81268 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 81268 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 |
|---|---|---|
| 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 |
| 81268-CPT | Moderate | Chimerism Anal W Cell Select, Chimerism Engraftment Analysis Post Transplantation Specimen Eg Hematopoietic Stem Cell Includes Comparison To Previously Performed Baseline Analyses With Cell Selection Eg Cd3 Cd33 Each Cell Type |
| 81269-CPT | Low | Hba1hba2 (Alpha Globin 1 And, Hba1hba2 (Alpha Globin 1 And Alpha Globin 2) (Egalpha Thalassemia Hb Bart Hydrops Fetalis Syndro Me Hbh Disease) Gene Analysis Duplicationdeletion Variants (Eg Exon 12) Hpa-9ab (V837m) |
| 81270-CPT | Low | Bone Marrow Genetic Test, A Lab Analysis Of Genetic Material That Can Indicate A Problem With How Bone Marrow Creates Blood Cells. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81268. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81268 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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