CPT 81349 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 11 - Office |
| Common Modifiers | None 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 81349 |
| Medicaid Fee Schedule | View Medicaid rates for 81349 |
National average reimbursement for CPT 81349 by major payers:
$1,037.39
$709.37
$1,057.52
$1,695.62
CPT 81349 vs. Other Molecular Pathology Procedures Codes
The CPT 81349 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 81349 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 |
|---|---|---|
| 81348-CPT | Low | Srsf2 Gene Common Variants, Srsf2 Serine And Arginine Rich Splicing Factor 2 Eg Myelodysplastic Syndrome Acute Myeloid Leukemia Gene Analysis Common Variants Eg P95h P95l |
| 81349-CPT | High | Cytogenomic (Genome-Wide) Anal, Cytogenomic (Genome-Wide) Analysis For Constitutional Chromosomal Abnormalities Interrogation Of Genomic Regions For Copy Number And Loss-Of-Heterozygosity Variants Low-Pass Sequencing Analysis |
| 81350-CPT | Low | Ugt1a1 Gene Common Variants, Ugt1a1 Udp Glucuronosyltransferase 1 Family Polypeptide A1 Eg Drug Metabolism Hereditary Unconjugated Hyperbilirubinemia Gilbert Syndrome Gene Analysis Common Variants Eg 28 36 37 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81349. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81349 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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