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See a sample rate comparisonCPT 81316 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | EC - ESA for non-cancer anemia JZ - Zero drug amount discarded/not administered to any patient |
| Complexity Level | Low |
| Medicare Fee Schedule | $207.31 national lab fee schedule rate (2026) · View Medicare rates for 81316 |
| Medicaid Fee Schedule | $196.945 median of the 8 states in the free preview · View Medicaid rates for 81316 |
National average reimbursement for CPT 81316 by major payers:
$190.17
$188.49
$232.50
$324.05
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CPT 81316
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
Mercy Medical Center
$602.43Published rateChristopher Raio
St Joseph Hospital
$433.33Published rateSharron Acosta M.D.P.A.
Sharron Acosta, M.D., P.A.
$258.83Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$207.31Published rateRouzbeh Afsari
Renal Consultants Medical Group
$87.06Published rate
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See a sample payer proposalCPT 81316 vs. Other Molecular Pathology Procedures Codes
The CPT 81316 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 81316 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 |
|---|---|---|
| 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. |
| 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 81316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81316 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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