CPT 81415 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 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 81415 |
| Medicaid Fee Schedule | View Medicaid rates for 81415 |
National average reimbursement for CPT 81415 by major payers:
$3,531.62
$2,927.76
$4,188.34
$6,597.40
CPT 81415 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81415 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 81415 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 |
|---|---|---|
| 81415-CPT | High | Exome (Eg Unexplaind Constituti Or Heritable Disord Or Syndro, Exome (Eg Unexplained Constitutional Or Heritable Disorder Or Syndrom |
| 81416-CPT | High | Exome (Eg Unexplained Constit, Exome (Eg Unexplained Constitutional Or Heritabledisorder Or Syndrome) Sequence Analysis Each Co Mparator Exome (Eg Parents Siblings) (List Separately In Addition To Code For Primary Procedure) |
| 81417-CPT | Moderate | Exome (Eg Unexplained Constit, Exome (Eg Unexplained Constitutional Or Heritabledisorder Or Syndrome) Re-Evaluation Of Previousl Y Obtained Exome Sequence (Eg Updated Knowledge Or Unrelated Conditionsyndrome) |
| 81425-CPT | High | Genom (Eg Unexplaind Constituti Or Heritable Disord Or Syndro, Genome (Eg Unexplained Constitutional Or Heritable Disorder Or Syndro |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81415 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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