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 81315 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.
Pml Raralpha Com Breakpoints, Pml Raralpha T 15 17 Promyelocytic Leukemia Retinoic Acid Receptor Alpha Eg Promyelocytic Leukemia Translocation Analysis Common Breakpoints Eg Intron 3 And Intron 6 Qualitative Or Quantitative
| 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 | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $207.31 national lab fee schedule rate (2026) · View Medicare rates for 81315 |
| Medicaid Fee Schedule | $196.945 median of the 8 states in the free preview · View Medicaid rates for 81315 |
National average reimbursement for CPT 81315 by major payers:
$174.35
$148.45
$201.56
$321.97
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 81315.
CPT 81315
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$456.08Published rateScurry County Hospital District, Cogdell Memorial Hospital
Scurry County Hospital District
$248.77Published rateChca Conroe Lp, Conroe Regional Medical Center
Chca Conroe Lp
$207.30Published rateSt Francis Hospital, Inc., St. Francis Eastside
St Francis Hospital Inc
$186.58Published rateNorthwest Texas Surgical Hospital, LLC, Northwest Texas Surgery Center
Northwest Texas Surgical Hospital LLC
$87.06Published 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 81315 vs. Other Molecular Pathology Procedures Codes
The CPT 81315 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 81315 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 |
| 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) |
| 81315-CPT | Low | Pml Raralpha Com Breakpoints, Pml Raralpha T 15 17 Promyelocytic Leukemia Retinoic Acid Receptor Alpha Eg Promyelocytic Leukemia Translocation Analysis Common Breakpoints Eg Intron 3 And Intron 6 Qualitative Or Quantitative |
| 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 81315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81315 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 81315) and we'll show you how you compare in 15 minutes or less.