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 |
| Medicare Fee Schedule | View Medicare rates for 81442 |
National average reimbursement for CPT 81442 by major payers:
$1,760.69
$898.76
$1,796.04
$2,968.40
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81442 | $1286.16 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 81442 | $252.88 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
United | 81442 | $1286.16 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81442 | $3215.40 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81442 | $361.26 | 1679551311 - CATHERINE LEE | 311425166 - COLUMBUS ARTHRITIS CENTER | OH | Rheumatology Physician (207RR0500X) |
United | 81442 | $601.50 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81442 | $252.88 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 81442 | $2865.68 | 1194797456 - DONALD HOELZEL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatrics Physician (208000000X) |
United | 81442 | $2865.68 | 1861468431 - TIZIANA CALIFANO | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 81442 | $2143.60 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81442 | $4715.92 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81442 | $4715.92 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81442 | $2546.60 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81442 | $601.50 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81442 | $2186.46 | 1285669036 - ROBERT RUBINO | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
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 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-CPT | High | Mitochondrial Gene, Nuclear Encoded Mitochondrial Genes Eg Neurologic Or 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-CPT | High | Ibmfs Seq Alys Pnl 30 Genes, 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, 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-CPT | High | Genetic Tstg Severe Inh Cond, 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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