Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 81313 Fee Schedule
Last Verified: October 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.
Genetic Test Prostate Cancer, A Lab Analysis Of Genetic Material That Can Indicate Prostate Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $255.05 national lab fee schedule rate (2026) · View Medicare rates for 81313 |
| Medicaid Fee Schedule | $255.045 median of the 8 states in the free preview · View Medicaid rates for 81313 |
National average reimbursement for CPT 81313 by major payers:
$206.75
$146.04
$238.02
$371.71
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 81313.
CPT 81313
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$561.11Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$336.67Published rateAnn Steck
$153.03Published rateCatherine Lee
Columbus Arthritis Center
$118.79Published rateLeon Home Health, LLC, Leon At Home
$84.05Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 81313 vs. Other Molecular Pathology Procedures Codes
The CPT 81313 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 81313 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 |
| 81313-CPT | Moderate | Genetic Test Prostate Cancer, A Lab Analysis Of Genetic Material That Can Indicate Prostate Cancer. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81314-CPT | Moderate | Pdgfra (Platelet-Derived Growt, Pdgfra (Platelet-Derived Growth Factor Receptor Alpha Polypeptide) (Eg Gastrointestinal Stromal Tumor [Gist]) Gene Analysis Targeted Sequence Analysis (Eg Exons 12 18) |
| 81316-CPT | Low | Pml Raralpha 1 Breakpoint, Pml Raralpha T 15 17 Promyelocytic Leukemia Retinoic Acid Receptor Alpha Eg Promyelocytic Leukemia Translocation Analysis Single Breakpoint Eg Intron 3 Intron 6 Or Exon 6 Qualitative Or Quantitative |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81313. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81313 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 81313) and we'll show you how you compare in 15 minutes or less.