CPT 81306 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 21 - Inpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81306 |
| Medicaid Fee Schedule | View Medicaid rates for 81306 |
National average reimbursement for CPT 81306 by major payers:
$221.18
$178.60
$263.29
$440.83
CPT 81306 vs. Other Molecular Pathology Procedures Codes
The CPT 81306 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 81306 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 81306. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81306 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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