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See a sample rate comparisonHealthcare 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81370 |
| Medicaid Fee Schedule | View Medicaid rates for 81370 |
National average reimbursement for CPT 81370 by major payers:

$332.20

$288.00

$409.85

$602.41
Choose a payer to see a sample of rates for CPT 81370.
Atlantic Health System Inc
Urology Specialists Of The Carolinas, PLLC
Atlantic Health System Inc
St Francis Hospital
Hroa 401k Plan
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 81370 vs. Other Molecular Pathology Procedures Codes
The CPT 81370 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 81370 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 |
|---|---|---|
| 81364-CPT | Moderate | Hbb (Hemoglobin Subunit Beta), Hbb (Hemoglobin Subunit Beta) (Eg Sickle Cell Anemia Beta Thalassemia Hemoglobinopathy) Full Gene Sequence (Eg Exon 12) Hpa-9ab (V837m) |
| 81370-CPT | Moderate | Transplant Match Genetic Test, A Lab Analysis That Identifies The Type Of Human Leukocyte Antigen (Hla). The Result Is Used To Identify The Best Donor And Recipient For Bone Marrow Or Cord Blood. |
| 81371-CPT | Moderate | Transplant Match Genetic Test, A Lab Analysis That Identifies The Type Of Human Leukocyte Antigen (Hla). The Result Is Used To Identify The Best Donor And Recipient For Bone Marrow Or Cord Blood. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81370. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81370 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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