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See a sample rate comparisonCPT 81305 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.
Myd88 Gene P Leu265pro Vrnt, Myd88 Myeloid Differentiation Primary Response 88 Eg Waldenstrom S Macroglobulinemia Lymphoplasmacytic Leukemia Gene Analysis P Leu265pro L265p Variant
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81305 |
| Medicaid Fee Schedule | View Medicaid rates for 81305 |
National average reimbursement for CPT 81305 by major payers:
$140.26
$107.60
$162.27
$265.88
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CPT 81305
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$385.88Published rateChristopher Raio
Mercy Medical Center
$208.38Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$175.22Published rateHans Henriquez
Progressive Medical Center, S.C.
$96.47Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$70.16Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81305 vs. Other Molecular Pathology Procedures Codes
The CPT 81305 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 81305 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. |
| 81305-CPT | Low | Myd88 Gene P Leu265pro Vrnt, Myd88 Myeloid Differentiation Primary Response 88 Eg Waldenstrom S Macroglobulinemia Lymphoplasmacytic Leukemia Gene Analysis P Leu265pro L265p Variant |
| 81306-CPT | Moderate | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
| 81307-CPT | Moderate | Genetic Test For Cancer, A Lab Analysis Of Genetic Material That Can Indicate Breast Or Pancreatic Cancer. 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 81305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81305 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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