CPT 81400 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 • 90 - Reference Laboratory |
| Complexity Level | Low |
National average reimbursement for CPT 81400 by major payers:
$55.17
$39.20
$65.61
$124.80
| 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 81400 | ||||||
United | 81400 | $185.63 | 1295791218 - PATRICIA AOUN | 274803222 - CITY OF HOPE MEDICAL FOUNDATION | CA | Molecular Genetic Pathology (Pathology) Physician (207ZP0007X) |
United | 81400 | $63.95 | 1598744856 - VHS SAN ANTONIO PARTNERS LLC, BAPTIST MEDICAL CENTER | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 81400 | $26.86 | 1316936990 - EL PASO COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER OF EL PASO | 752668018 | TX | General Acute Care Hospital (282N00000X) |
United | 81400 | $63.95 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 81400 | $38.38 | 1679578439 - MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, CHRISTUS MOTHER FRANCES HOSPITAL TYLER | 750818167 - (TX) MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 81400 | $350.98 | 1831403211 - HIND AL SAIF | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81400 | $57.56 | 1689676835 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 81400 | $350.98 | 1730616541 - BARRY TONG | 943281660 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81400 | $167.75 | 1750834677 - MONICA STAMP | 475502470 - (CA) REGENTS OF THE UNIVERSITY OF CALIFORNIA | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81400 | $63.95 | 1669483590 - METHUSA MEJIA | 593765949 - (CA) PALM DESERT PEDIATRICS, INC. | CA | Ph.D. Medical Genetics (170100000X) |
United | 81400 | $26.86 | 1437471810 - JAIME BAREA | 842664261 - (CA) DNAFORWARD PC | CA | Clinical Biochemical Genetics Physician (207SG0202X) |
United | 81400 | $85.36 | 1831403211 - HIND AL SAIF | 541581185 - MCV ASSOCIATED PHYSICIANS | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81400 | $103.72 | 1073054722 - HELIO COSTA | 770465765 | CA | Clinical Molecular Genetics Physician (207SG0203X) |
United | 81400 | $350.98 | 1033464821 - JESSICA TENNEY | 943281660 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81400 | $26.86 | 1952424079 - CATHERINE KARIMOV | 272273686 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
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 81400 vs. Other Molecular Pathology Procedures Codes
The CPT 81400 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 81400 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 |
|---|---|---|
| 81383-CPT | Low | Hla Class Ii Typing, High Resolution (Ie, Alleles Or Allele Groups); One Allele Or Allele Group (Eg, Hla-Dqb1*06:02p), Each |
| 81400-CPT | Low | Molecular Pathology Procedure Level 1 (Eg Identification Of Single Germline Variant [Eg Snp] By Techniques Such As Restriction Enzyme Digestion Or Melt Curve Analysis) (Desc Revised 7/1/2017) |
| 81401-CPT | Low | Molecular Pathology Procedure, Level 2 (Eg, 2-10 Snps, 1 Methylated Variant, Or 1 Somatic Variant (Typically Using Nonsequencing Target Variant Analysis), Or Detection Of A Dynamic Mutation Disorder/Triplet Repeat) Abcc8 (Atp-Binding Cassette, Sub-Family C (Cftr/Mr |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81400 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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