CPT 81360 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81360 |
| Medicaid Fee Schedule | View Medicaid rates for 81360 |
National average reimbursement for CPT 81360 by major payers:
$174.56
$118.45
$175.93
$301.62
CPT 81360 vs. Other Molecular Pathology Procedures Codes
The CPT 81360 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 81360 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 |
|---|---|---|
| 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 |
| 81360-CPT | Low | Zrsr2 Gene Common Variants, Zrsr2 Zinc Finger Ccch Type Rna Binding Motif And Serine Arginine Rich 2 Eg Myelodysplastic Syndrome Acute Myeloid Leukemia Gene Analysis Common Variant S Eg E65fs E122fs R448fs |
| 81361-CPT | Low | Hbb (Hemoglobin Subunit Beta), Hbb (Hemoglobin Subunit Beta) (Eg Sickle Cell Anemia Beta Thalassemia Hemoglobinopathy) Common Variant(S) (Eg Hbs Hbc Hbe) (Eg Exon 12) Hpa-9ab (V837m) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81360. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81360 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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