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See a sample rate comparisonCPT 81355 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.
Drug Metabolism Genetic Test, A Lab Analysis Of Genetic Material To Find The Best Drug Therapy For A Condition. 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 21 - Inpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81355 |
| Medicaid Fee Schedule | View Medicaid rates for 81355 |
National average reimbursement for CPT 81355 by major payers:
$70.97
$54.31
$81.36
$152.09
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CPT 81355
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$194.04Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$88.20Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$65.04Published rateNicole Schwab
Allergy & Asthma Of Dupage, S.C.
$48.51Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$35.27Published rate
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See a sample payer proposalCPT 81355 vs. Other Molecular Pathology Procedures Codes
The CPT 81355 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 81355 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 |
|---|---|---|
| 81353-CPT | Moderate | Zrsr2 (Zinc Finger Ccch-Type, Zrsr2 (Zinc Finger Ccch-Type Rna Binding Motif And Serinearginine-Rich 2) (Eg Myelodysplastic Syndrome Acute Myeloid Leukemia) Gene Analysis Common Variant(S) (Eg E65fs E122fs R448fs) |
| 81355-CPT | Low | Drug Metabolism Genetic Test, A Lab Analysis Of Genetic Material To Find The Best Drug Therapy For A Condition. Types Of Analysis Include Gene Variants Full Sequence Analysis Or Breakpoints. |
| 81357-CPT | Low | U2af1 Gene Common Variants, U2af1 U2 Small Nuclear Rna Auxiliary Factor 1 Eg Myelodysplastic Syndrome Acute Myeloid Leukemia Gene Analysis Common Variants Eg S34f S34y Q157r Q157p |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81355. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81355 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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