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See a sample rate comparisonCPT 81351 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.
Tp53 (Tumor Protein 53) Gene Analysis; Full Gene, Tp53 (Tumor Protein 53) (Eg Li-Fraumeni Syndrome) Gene Analysis; Full Gene Sequence
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81351 |
| Medicaid Fee Schedule | View Medicaid rates for 81351 |
National average reimbursement for CPT 81351 by major payers:
$543.99
$385.65
$582.05
$896.43
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CPT 81351
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,412.07Published rateChristopher Raio
St Joseph Hospital
$762.52Published rateNicole Schwab
Allergy & Asthma Of Dupage, S.C.
$513.48Published rateChristopher Raio
St Francis Hospital
$385.11Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$256.73Published rate
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See a sample payer proposalCPT 81351 vs. Other Molecular Pathology Procedures Codes
The CPT 81351 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 81351 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 |
|---|---|---|
| 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 |
| 81351-CPT | Moderate | Tp53 (Tumor Protein 53) Gene Analysis; Full Gene, Tp53 (Tumor Protein 53) (Eg Li-Fraumeni Syndrome) Gene Analysis; Full Gene Sequence |
| 81352-CPT | Moderate | U2af1 (U2 Small Nuclear Rna Au, U2af1 (U2 Small Nuclear Rna Auxiliary Factor 1) (Eg Myelodysplastic Syndrome Acute Myeloid Leukemia) Gene Analysis Common Variants (Eg S34f S34yq157r Q157p) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81351. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81351 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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