CPT 81422 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 • 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 | Moderate |
National average reimbursement for CPT 81422 by major payers:
$650.84
$477.08
$713.56
$1,109.22
| 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 81422 | ||||||
United | 81422 | $4165.35 | 1033464821 - JESSICA TENNEY | 943281660 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $1230.91 | 1073054722 - HELIO COSTA | 770465765 | CA | Clinical Molecular Genetics Physician (207SG0203X) |
United | 81422 | $4165.35 | 1972034841 - DAVID BLAIR | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $948.80 | 1780818302 - NIKKI MADSON | 943281666 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81422 | $4165.35 | 1831403211 - HIND AL SAIF | 943281666 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $797.00 | 1780818302 - NIKKI MADSON | 943281666 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81422 | $3094.50 | 1275612749 - NICOLA LONGO | 954377219 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $3748.80 | 1033464821 - JESSICA TENNEY | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $336.98 | 1316936990 - EL PASO COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER OF EL PASO | 746000756 - (TX) EL PASO COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 81422 | $336.26 | 1396014866 - KATHRYN SINGH | 271504911 - (CA) MEMORIALCARE MEDICAL FOUNDATION | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81422 | $1203.50 | 1952424079 - CATHERINE KARIMOV | 222095812 - UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY INC | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $797.00 | 1255548327 - JOSE CAMACHO | 943281657 | CA | Clinical Genetics (M.D.) Physician (207SG0201X) |
United | 81422 | $3516.53 | 1235165796 - WAYNE GRODY | 954377219 | CA | Molecular Genetic Pathology (Pathology) Physician (207ZP0007X) |
United | 81422 | $3516.53 | 1902531288 - DAYNA RICHARDS | 954377219 | CA | Genetic Counselor (M.S.) (170300000X) |
United | 81422 | $1161.34 | 1164541181 - MATTHEW DEARDORFF | 274470693 | 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 81422 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81422 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 81422 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 |
|---|---|---|
| 81420-CPT | Moderate | Fetal Chromosomal Aneuploidy (Eg, Trisomy 21, Monosomy X) Genomic Sequence Analysis Panel, Circulating Cell-Free Fetal Dna In Maternal Blood, Must Include Analysis Of Chromosomes 13, 18, And 21 |
| 81422-CPT | Moderate | Fetal Chromosomal Microdeletion(S) Genomic Sequence Analysis (Eg Digeorge Syndrome Cri-Du-Chat Syndrome) Circulating Cell-Free Fetal Dna In Maternal Blood |
| 81441-CPT | High | Inherited Bone Marrow Failure Syndromes (Ibmfs) (Eg, Fanconi Anemia, Dyskeratosis Congenita, Diamond-Blackfan Anemia, Shwachman-Diamond Syndrome, Gata2 Deficiency Syndrome, Congenital Amegakaryocytic Thrombocytopenia) Sequence Analysis Panel, Must Include Sequencing Of At Least 30 Genes, Including Brca2, Brip1, Dkc1, Fanca, Fancb, Fancc, Fancd2, Fance, Fancf, Fancg, Fanci, Fancl, Gata1, Gata2, Mpl, Nhp2, Nop10, Palb2, Rad51c, Rpl11, Rpl35a, Rpl5, Rps10, Rps19, Rps24, Rps26, Rps7, Sbds, Tert, And Tinf2 |
| 81442-CPT | High | Noonan Spectrum Disorders (Eg Noonan Syndrome Cardio-Facio-Cutaneous Syndrome Costello Syndrome Leopard Syndrome Noonan-Like Syndrome) Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 12 Genes Including Braf Cbl Hras Kras Map2k1 Map2k2 Nras Ptpn11 Raf1 Rit1 Shoc2 And Sos1 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81422. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81422 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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