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See a sample rate comparisonCPT 81430 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.
Hearing Loss Sequence Analys, Hearing Loss Eg Nonsyndromic Hearing Loss Usher Syndrome Pendred Syndrome Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 60 Genes Including Cdh23 Clrn1 Gjb2 Gpr98 Mtrnr1 Myo7a Myo15a Pcdh15 Otof Slc26a4 Tmc1 Tmprss3 Ush1c Ush1g Ush2a And Wfs1
| 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 | 90 - Reference Laboratory XU - Unusual Non-Overlapping Service |
| Complexity Level | High |
| Medicare Fee Schedule | $1,625.00 national lab fee schedule rate (2026) · View Medicare rates for 81430 |
| Medicaid Fee Schedule | $1,625.00 median of the 8 states in the free preview · View Medicaid rates for 81430 |
National average reimbursement for CPT 81430 by major payers:
$1,166.10
$995.24
$1,542.46
$2,264.10
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CPT 81430
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,575.00Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,625.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$975.00Published rateRenal Consultants Medical Group
$682.50Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$650.00Published rate
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See a sample payer proposalCPT 81430 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81430 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 81430 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) |
| 81430-CPT | High | Hearing Loss Sequence Analys, Hearing Loss Eg Nonsyndromic Hearing Loss Usher Syndrome Pendred Syndrome Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 60 Genes Including Cdh23 Clrn1 Gjb2 Gpr98 Mtrnr1 Myo7a Myo15a Pcdh15 Otof Slc26a4 Tmc1 Tmprss3 Ush1c Ush1g Ush2a And Wfs1 |
| 81431-CPT | Moderate | Hearing Loss Dup Del Analys, Hearing Loss Eg Nonsyndromic Hearing Loss Usher Syndrome Pendred Syndrome Duplication Deletion Analysis Panel Must Include Copy Number Analyses For Strc And Dfnb1 Deletions In Gjb2 And Gjb6 Genes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81430 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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