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See a sample rate comparisonCPT 81331 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.
Test For Genetic Syndrome, A Lab Analysis Of Genetic Material That Can Indicate A Problem With How The Bodys Hormones Work (Prader-Willi Syndrome Or Angelman Syndrome). 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 |
| Common Modifiers | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $51.07 national lab fee schedule rate (2026) · View Medicare rates for 81331 |
| Medicaid Fee Schedule | $51.07 median of the 8 states in the free preview · View Medicaid rates for 81331 |
National average reimbursement for CPT 81331 by major payers:
$45.81
$31.35
$58.48
$100.35
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CPT 81331
5 of 25 sample ratesHigher to lower in this preview
Lasalle Parish Hospital Service Dist No1, Hardtner Medical Center
Hardtner Medical Center
$76.61Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$51.07Published rateHans Henriquez
Progressive Medical Center, S.C.
$28.09Published rateAaron Askew
The Orthopedic And Neurosurgical Center Of The Cascades
$21.45Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$17.87Published rate
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See a sample payer proposalCPT 81331 vs. Other Molecular Pathology Procedures Codes
The CPT 81331 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 81331 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 |
| 81329-CPT | Low | Smn1 Gene Dos Deletion Alys, Smn1 Survival Of Motor Neuron 1 Telomeric Eg Spinal Muscular Atrophy Gene Analysis Dosage Deletion Analysis Eg Carrier Testing Includes Smn2 Survival Of Motor Neuron 2 Centromeric Analysis If Performed |
| 81330-CPT | Low | Genetic Test For Niemann-Pick, A Lab Analysis Of Genetic Material That Can Indicate Difficulty Breaking Down Fats Properly (Niemann-Pick Disease). Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81331-CPT | Low | Test For Genetic Syndrome, A Lab Analysis Of Genetic Material That Can Indicate A Problem With How The Bodys Hormones Work (Prader-Willi Syndrome Or Angelman Syndrome). 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 81331. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81331 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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