CPT 81434 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 |
| Common Modifiers | • None • 90 - Reference Laboratory • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81434 |
National average reimbursement for CPT 81434 by major payers:
$460.14
$367.31
$629.83
$887.72
| 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 81434 | ||||||
United | 81434 | $252.88 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81434 | $444.01 | 1134127301 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81434 | $251.12 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81434 | $597.91 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81434 | $478.33 | 1255766531 - MARISSA LIVERIS | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Physician Assistant (363A00000X) |
United | 81434 | $776.03 | 1437126745 - ALAN MELTZER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatrics Physician (208000000X) |
United | 81434 | $1315.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81434 | $602.10 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 81434 | $657.70 | 1366428401 - AARON ASKEW | 931224010 - PRAXIS HEALTH, P.C. | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 81434 | $842.94 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81434 | $252.88 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 81434 | $789.24 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81434 | $240.83 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81434 | $358.75 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 81434 | $1315.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
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 81434 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81434 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 81434 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, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Sequence Analysis |
| 81432-CPT | Moderate | Hereditary Breast Cancer-Related Disorders (Eg Hereditary Breast Cancer Hereditary Ovarian Cancer Hereditary Endometrial Cancer); Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 14 Genes Including Brca1 Brca2 Cdh1 Mlh1 Msh2 Msh6 Palb2 Pten Stk11 And Tp53 (Desc Revised 1/1/2018) |
| 81433-CPT | Moderate | Hereditary Breast Cancer-Related Disorder (Eg Hereditary Breast Cancer Hereditary Ovarian Cancer Hereditary Endometrial Cancer); Duplication/Deletion Analysis Panel Must Include Analyses For Brca1 Brca2 Mlh1 Msh2 And Stk11 |
| 81434-CPT | Moderate | Hereditary Retinal Disorders (Eg Retinal Pigmentosa Leber Congential Amaurosis Cone-Rod Dystrophy) Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 15 Genes Includingabca4 Cnga1 Crb1 Eys Pde6a Prpf31 Prph2 Rdh12 Rho Rp1 Rp2 Rpe65 Rpgr And Ush2a |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81434. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81434 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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