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See a sample rate comparisonCPT 81431 Fee Schedule
Last Verified: October 2026
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.
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
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $679.57 national lab fee schedule rate (2026) · View Medicare rates for 81431 |
| Medicaid Fee Schedule | $679.57 median of the 8 states in the free preview · View Medicaid rates for 81431 |
National average reimbursement for CPT 81431 by major payers:
$585.21
$416.18
$653.75
$959.60
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CPT 81431
5 of 25 sample ratesHigher to lower in this preview
Overlook Hospital, Atlantic Health Systems
Atlantic Health System Inc
$908.48Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$679.57Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$501.14Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$285.42Published rateRouzbeh Afsari
Renal Consultants Medical Group
$285.42Published rate
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See a sample payer proposalCPT 81431 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81431 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 81431 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 (, 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 Microdeletio, Fetal Chromosomal Microdeletion(S) Genomic Sequence Analysis (Eg Digeorge Syndrome Cri-Du-Chat Syndrome) Circulating Cell-Free Fetal Dna In Maternal Blood |
| 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 81431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81431 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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