CPT 81442 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 81442 by major payers:
$1,760.69
$898.76
$1,796.04
$3,106.34
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 81442 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81442 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 81442 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 |
|---|---|---|
| 81440 | High | Nuclear Encoded Mitochondrial Genes(Eg Neurologicor Myopathic Phenotypes) Genomic Sequence Panel Must Include Analysis Of At Least 100 Genes Including Bcs1l C10orf2 Coq2 Cox10 Dguok Mpv17 Opa1 Pdss2 Polg Polg2 Rrm2b Sco1 Sco2 Slc25a4 Sucla2 Suclg1 Taz Tk2 And Tymp |
| 81441 | 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 | 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 |
| 81443 | High | Genetic Testing For Severe Inherited Conditions (Eg, Cystic Fibrosis, Ashkenazi Jewish-Associated Disorders (Eg, Bloom Syndrome, Canavan Disease, Fanconi Anemia Type C, Mucolipidosis Type Vi, Gaucher Disease, Tay-Sachs Disease), Beta Hemoglobinopathies, Phenylketonuria, Galactosemia), Genomic Sequence Analysis Panel, Must Include Sequencing Of At Least 15 Genes (Eg, Acadm, Arsa, Aspa, Atp7b, Bckdha, Bckdhb, Blm, Cftr, Dhcr7, Fancc, G6pc, Gaa, Galt, Gba, Gbe1, Hbb, Hexa, Ikbkap, Mcoln1, Pah) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81442. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81442 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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