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See a sample rate comparisonCPT 81285 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.
Gene Test Friedreich Ataxia, Lab Analysis Of Genetic Material That Can Indicate Friedreich Ataxia A Disease That Causes Progressive Nervous System Damage And Movement Problems.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81285 |
| Medicaid Fee Schedule | View Medicaid rates for 81285 |
National average reimbursement for CPT 81285 by major payers:
$217.20
$168.46
$254.43
$416.84
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CPT 81285
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$604.63Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$326.50Published rateChristopher Raio
St Francis Hospital
$274.56Published rateChristopher Raio
St Joseph Hospital
$164.90Published rateProgressive Emergency Physicians PLLC
$100.08Published rate
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See a sample payer proposalCPT 81285 vs. Other Molecular Pathology Procedures Codes
The CPT 81285 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 81285 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 |
|---|---|---|
| 81284-CPT | Low | Gene Test Friedreich Ataxia, Lab Analysis Of Genetic Material That Can Indicate Friedreich Ataxia A Disease That Causes Progressive Nervous System Damage And Movement Problems. |
| 81285-CPT | Moderate | Gene Test Friedreich Ataxia, Lab Analysis Of Genetic Material That Can Indicate Friedreich Ataxia A Disease That Causes Progressive Nervous System Damage And Movement Problems. |
| 81286-CPT | Moderate | Gene Test Friedreich Ataxia, Lab Analysis Of Genetic Material That Can Indicate Friedreich Ataxia A Disease That Causes Progressive Nervous System Damage And Movement Problems. |
| 81287-CPT | Low | Genetic Test For A Brain Tumor, A Lab Analysis Of Genetic Material That Can Indicate The Potential For Developing A Brain Tumor. 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 81285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81285 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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