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See a sample rate comparisonCPT 81294 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81294 |
| Medicaid Fee Schedule | View Medicaid rates for 81294 |
National average reimbursement for CPT 81294 by major payers:
$159.97
$120.89
$209.34
$312.02
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CPT 81294
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$445.28Published rateChristopher Raio
St Joseph Hospital
$267.17Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$191.53Published rateProgressive Medical Center Sc
Progressive Medical Center, S.C.
$104.87Published rateMolly Mcintosh
Baycare Medical Group Inc
$80.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81294 vs. Other Molecular Pathology Procedures Codes
The CPT 81294 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 81294 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 81294. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81294 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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