CPT 81293 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 |
| Common Modifiers | None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81293 |
| Medicaid Fee Schedule | View Medicaid rates for 81293 |
National average reimbursement for CPT 81293 by major payers:
$250.08
$183.47
$283.21
$512.51
CPT 81293 vs. Other Molecular Pathology Procedures Codes
The CPT 81293 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 81293 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 |
|---|---|---|
| 81288-CPT | Low | Mlh1 (Mutl Homolog 1 Colon Ca, Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis Promoter Methylation Analysis |
| 81292-CPT | Moderate | Mlh1 (Mutl Homolog 1 Colon Ca, Mlh1 (Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis Full Sequenceanalysis |
| 81293-CPT | Moderate | Mlh1 Gene Known Variants, Mlh1 Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2 Eg Hereditary Non Polyposis Colorectal Cancer Lynch Syndrome Gene Analysis Known Familial Variants |
| 81294-CPT | Low | Mlh1 Gene Dup Delete Variant, Mlh1 Mutl Homolog 1 Colon Cancer Nonpolyposis Type 2 Eg Hereditary Non Polyposis Colorectal Cancer Lynch Syndrome Gene Analysis Duplication Deletion Variants |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81293. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81293 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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