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See a sample rate comparisonCPT 81416 Fee Schedule
Last Verified: October 2026
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.
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)
| 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 81416 |
| Medicaid Fee Schedule | View Medicaid rates for 81416 |
National average reimbursement for CPT 81416 by major payers:
$7,543.40
$7,347.20
$9,972.28
$16,563.44
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CPT 81416
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$26,400.00Published rateMelanie Smith
Atlantic Health System Inc
$12,031.67Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$8,849.28Published rateSacred Heart Health System Inc, Sacred Heart Home Care
Sacred Heart Health System Inc
$5,040.00Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$4,800.00Published rate
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See a sample payer proposalCPT 81416 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81416 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 81416 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 81416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81416 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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