CPT 81279 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 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81279 |
| Medicaid Fee Schedule | View Medicaid rates for 81279 |
National average reimbursement for CPT 81279 by major payers:
$163.39
$113.42
$175.91
$275.76
CPT 81279 vs. Other Molecular Pathology Procedures Codes
The CPT 81279 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 81279 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 |
|---|---|---|
| 81276-CPT | Low | Kras (Kirsten Rat Sarcoma Vira, Kras (Kirsten Rat Sarcoma Viral Oncogene Homolog) (Eg Carcinoma) Gene Analysis Additional Variant(S) (Eg Codon 61 Codon 146) |
| 81277-CPT | High | Cytogenomic Neoplasia (Genome-, Cytogenomic Neoplasia (Genome-Wide) Microarray Analysis Interrogation Of Genomic Regions For Copy Number And Loss-Of-Heterozygosity Variants For Chromosomal Abnormalities |
| 81278-CPT | Low | Igh Bcl2 Translocation Alys, Igh Bcl2 T 14 18 Eg Follicular Lymphoma Translocation Analysis Major Breakpoint Region Mbr And Minor Cluster Region Mcr Breakpoints Qualitative Or Quantitative |
| 81279-CPT | Low | Jak2 (Janus Kinase 2) Targeted Sequence Analysis, Jak2 (Janus Kinase 2) (Eg Myeloproliferative Disorder) Targeted Sequence Analysis (Eg Exons 12 And 13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81279. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81279 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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