CPT 81361 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 • 11 - Office |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
National average reimbursement for CPT 81361 by major payers:
$161.35
$107.15
$161.79
$275.02
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 81361 | ||||||
United | 81361 | $283.48 | 1073054722 - HELIO COSTA | 770465765 | CA | Clinical Molecular Genetics Physician (207SG0203X) |
United | 81361 | $509.42 | 1750834677 - MONICA STAMP | 475502470 - (CA) REGENTS OF THE UNIVERSITY OF CALIFORNIA | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $591.59 | 1932343316 - KEVIN MCDONNELL | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81361 | $174.80 | 1831403211 - HIND AL SAIF | 943281660 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81361 | $863.34 | 1033464821 - JESSICA TENNEY | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81361 | $73.41 | 1497821763 - VALERIE WATIKER | 880176637 - (NV) WM N EVANS M D LTD DBA CHILDRENS HEART CENTER | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81361 | $458.47 | 1750834677 - MONICA STAMP | 475502470 - (CA) REGENTS OF THE UNIVERSITY OF CALIFORNIA | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $218.50 | 1194701250 - VINAYA MURTHY | 943281660 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $507.35 | 1295791218 - PATRICIA AOUN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Molecular Genetic Pathology (Pathology) Physician (207ZP0007X) |
United | 81361 | $959.28 | 1093975435 - ALLYSON SCOTT | 943281660 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $157.33 | 1740910330 - BRENDEN PHUNG | 621647259 - TENNESSEE ONCOLOGY PLLC | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $157.33 | 1649944976 - GRACE KAVANAUGH | 621647259 - TENNESSEE ONCOLOGY PLLC | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81361 | $507.35 | 1124551312 - FEI FEI | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Molecular Genetic Pathology (Pathology) Physician (207ZP0007X) |
United | 81361 | $959.28 | 1063617298 - JOSEPH SHIEH | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81361 | $959.28 | 1346239159 - JULIANNE WOJCIAK | 943281660 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81361 vs. Other Molecular Pathology Procedures Codes
The CPT 81361 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 81361 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 |
|---|---|---|
| 81360-CPT | Low | "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) (Eg, Sickle Cell Anemia, Beta Thalassemia, Hemoglobinopathy); Common Variant(S) (Eg, Hbs, Hbc, Hbe) |
| 81362-CPT | Moderate | Hbb (Hemoglobin, Subunit Beta) (Eg, Sickle Cell Anemia, Beta Thalassemia, Hemoglobinopathy); Known Familial Variant(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81361. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81361 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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