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See a sample rate comparisonCPT 81272 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.
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
| 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 90 - Reference Laboratory XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81272 |
| Medicaid Fee Schedule | View Medicaid rates for 81272 |
National average reimbursement for CPT 81272 by major payers:
$291.03
$202.04
$315.34
$480.22
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CPT 81272
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$724.92Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$391.46Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$329.51Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$197.71Published 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
$115.33Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81272 vs. Other Molecular Pathology Procedures Codes
The CPT 81272 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 81272 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 |
|---|---|---|
| 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 |
| 81273-CPT | Low | Pathology Panel/Obstetric, 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) |
| 81274-CPT | Moderate | Huntington Disease Test, A Lab Analysis Of Genetic Material That Can Indicate Huntington Disease Which Causes The Breakdown Of Nerve Cells In The Brain. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81272. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81272 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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