CPT 81443 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 90 - Reference Laboratory XS - Separate Structure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 81443 |
National average reimbursement for CPT 81443 by major payers:
$1,802.56
$1,462.29
$2,269.26
$3,369.99
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81443 | $3672.84 | 1588098172 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | 463316332 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $1028.40 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 81443 | $1322.22 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $1028.40 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 81443 | $1028.40 | 1174078281 - DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC, ORLANDO DERMATOLOGY CENTER | 208048424 - (FL) DERMATOLOGY AND SKIN CANCER SURGERY CENTER LLC | FL | Dermatology Physician (207N00000X) |
United | 81443 | $1469.14 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $1805.67 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81443 | $1805.67 | 1972501252 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81443 | $1028.40 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 81443 | $1224.28 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | 81443 | $2908.89 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $3273.37 | 1194797456 - DONALD HOELZEL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatrics Physician (208000000X) |
United | 81443 | $1322.22 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $1469.14 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81443 | $1028.40 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
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 81443 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81443 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 81443 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 |
|---|---|---|
| 81419-CPT | High | Epilepsy Gen Seq Alys Panel, Epilepsy Genomic Sequence Analysis Panel Must Include Analyses For Aldh7a1 Cacna1a Cdkl5 Chd2 Gabrg2 Grin2a Kcnq2 Mecp2 Pcdh19 Polg Prrt2 Scn1a Scn1b Scn2a Scn8a Slc2a1 Slc9a6 Stxbp1 Syngap1 Tcf4 Tpp1 Tsc1 Tsc2 And Zeb2 |
| 81439-CPT | Moderate | Hereditary Cardiomyopathy (Eg Hypertrophic Cardiomyopathy Dilated Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy) Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 5 Cardiomyopathy-Related Genes (Eg Dsg2 Mybpc3 Myh7 Pkp2 Ttn) (Desc Revised 1/1/2018) |
| 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 |
| 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 81443. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81443 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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