CPT 81411 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Pathology and Laboratory Procedures • Genomic Sequencing Procedures and Other Molecular Multianalyte Assays |
| Common Place of Service | • 81 - Independent Laboratory • 11 - Office |
| Common Modifiers | • None • 90 - Reference Laboratory • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 81411 by major payers:
$1,007.71
$826.92
$1,241.16
$1,968.56
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 81411 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81411 code is part of the Pathology and Laboratory Procedures services used for Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. 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 81411 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 |
|---|---|---|
| 81410 | Moderate | Aortic Dysfunction Or Dilation (Eg Marfan Syndrome Loeys Dietz Syndrome Ehler Danlos Syndrome Type Iv Arterial Tortuosity Syndrome); Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 9 Genes Including Fbn1 Tgfbr1 Tgfbr2 Col3a1 Myh11 Acta2 Slc2a10 Smad3 And Mylk |
| 81411 | High | Aortic Dysfunction Or Dilation (Eg, Marfan Syndrome, Loeys Dietz Syndrome, Ehler Danlos Syndrome Type Iv, Arterial Tortuosity Syndrome); Duplication/Deletion Analysis Panel, Must Include Analyses For Tgfbr1, Tgfbr2, Myh11, And Col3a1 |
| 81413 | Moderate | Cardiac Ion Channelopathies (Eg Brugada Syndrome Long Qt Syndrome Short Qt Syndrome Catecho- Laminergic Polymorphic Ventricular Tachycardia); Genomic Sequence Analysis Panel Must Include Se- Quencing Of At Least 10 Genes Including Ank2 Casq2 Cav3 Kcne1 Kcne2 Kcnh2 Kcnj2 Kcnq1 Ryr2 And Scn5a |
| 81415 | High | Exome (Eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Sequence Analysis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81411. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81411 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
|---|