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See a sample rate comparisonCPT 81296 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.
Msh2 Gene Known Variants, Msh2 Muts Homolog 2 Colon Cancer Nonpolyposis Type 1 Eg Hereditary Non Polyposis Colorectal Cancer Lynch Syndrome Gene Analysis Known Familial Variants
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None 90 - Reference Laboratory |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81296 |
| Medicaid Fee Schedule | View Medicaid rates for 81296 |
National average reimbursement for CPT 81296 by major payers:
$241.12
$150.91
$279.24
$520.30
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CPT 81296
5 of 25 sample ratesHigher to lower in this preview
Maricopa County Special Health Care District, Valleywise Health
$405.27Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$337.73Published rateMichael Shuler
Athens Orthopedic Clinic, PA
$202.64Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$96.05Published rateDermatology And Skin Cancer Surgery Center, LLC, Orlando Dermatology Center
Dermatology And Skin Cancer Surgery Center LLC
$54.31Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81296 vs. Other Molecular Pathology Procedures Codes
The CPT 81296 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 81296 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 |
|---|---|---|
| 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 |
| 81295-CPT | Moderate | Msh2 (Muts Homolog 2 Colon Ca, Msh2 (Muts Homolog 2 Colon Cancer Nonpolyposis Type 1) (Eg Hereditary Non-Polyposis Colorectal Cancer Lynch Syndrome) Gene Analysis Full Sequenceanalysis |
| 81296-CPT | Moderate | Msh2 Gene Known Variants, Msh2 Muts Homolog 2 Colon Cancer Nonpolyposis Type 1 Eg Hereditary Non Polyposis Colorectal Cancer Lynch Syndrome Gene Analysis Known Familial Variants |
| 81297-CPT | Low | Msh2 Gene Dup Delete Variant, Msh2 Muts Homolog 2 Colon Cancer Nonpolyposis Type 1 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 81296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81296 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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