CPT 81271 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 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81271 |
National average reimbursement for CPT 81271 by major payers:
$113.84
$83.98
$128.61
$209.54
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81271 | $54.79 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81271 | $57.54 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 81271 | $301.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81271 | $301.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81271 | $162.76 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81271 | $137.00 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 81271 | $75.34 | 1053725994 - HANS HENRIQUEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 81271 | $75.34 | 1407996564 - AUSENCIO NUNEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 81271 | $162.76 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81271 | $82.20 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81271 | $177.82 | 1437126745 - ALAN MELTZER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatrics Physician (208000000X) |
United | 81271 | $57.54 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 81271 | $82.20 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81271 | $183.14 | 1023335643 - VINEETHA ALIAS | 521958352 - ATLANTIC HEALTH SYSTEM INC | PA | Pediatrics Physician (208000000X) |
United | 81271 | $68.50 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Diagnostic Radiology Physician (2085R0202X) |
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 81271 vs. Other Tier 1 Molecular Pathology Procedures Codes
The CPT 81271 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 81271 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 |
|---|---|---|
| 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 |
| 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. |
| 81271-CPT | Low | Huntington Disease Test, A Lab Analysis Of Genetic Material That Can Indicate Huntington Disease Which Causes The Breakdown Of Nerve Cells In The Brain. |
| 81272-CPT | Moderate | Kit Gene Targeted Seq Analys, Kit V Kit Hardy Zuckerman 4 Feline Sarcoma Viral Oncogene Homolog Eg Gastrointestinal Stromal Tumor Gist Acute Myeloid Leukemia Melanoma Gene Analysis Targeted Sequence Analysis Eg Exons 8 11 13 17 18 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81271. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81271 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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