CPT 81449 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary • XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81449 |
National average reimbursement for CPT 81449 by major payers:
$525.97
$365.46
$567.18
$899.89
| 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 81449 | ||||||
United | 81449 | $251.12 | 1366442600 - MICHAEL JACOBSON | 541958039 - HROA 401K PLAN | VA | Otolaryngology Physician (207Y00000X) |
United | 81449 | $209.27 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 81449 | $358.75 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81449 | $358.75 | 1679551311 - CATHERINE LEE | 311425166 - COLUMBUS ARTHRITIS CENTER | OH | Rheumatology Physician (207RR0500X) |
United | 81449 | $251.12 | 1366428401 - AARON ASKEW | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 81449 | $239.16 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81449 | $209.27 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 81449 | $597.31 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81449 | $1315.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81449 | $251.11 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
United | 81449 | $251.11 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 81449 | $251.12 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81449 | $1315.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81449 | $440.92 | 1013915149 - BAYCARE HOME CARE, INC., DBA SARASOTA MEMORIAL HOME CARE | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 81449 | $358.75 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
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 81449 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81449 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 81449 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 |
|---|---|---|
| 81445-CPT | Moderate | Targeted Genomic Sequence Analysis Panel Solid Organ Neoplasm 5-50 Genes (Eg Alk Braf Cdkn2a Egfr Erbb2 Kit Kras Met Nras Pdgfra Pdgfrb Pgr Pik3ca Pten Ret) Interrogation For Sequence Variants And Copy Number Variants Or Rearrangements If Performed; Dna Analysis Or Combined Dna And Rna Analysis (Desc Rvsd 1/1/23) |
| 81449-CPT | Moderate | Targeted Genomic Sequence Analysis Panel, Solid Organ Neoplasm, 5-50 Genes (Eg, Alk, Braf, Cdkn2a, Egfr, Erbb2, Kit, Kras, Met, Nras, Pdgfra, Pdgfrb, Pgr, Pik3ca, Pten, Ret), Interrogation For Sequence Variants And Copy Number Variants Or Rearrangements, If Performed; Rna Analysis |
| 81450-CPT | Moderate | Targeted Genomic Sequence Analysis Panel Hematolymphoid Neoplasm Or Disorder 5-50 Genes (Eg Braf Cebpa Dnmt3a Ezh2 Flt3 Idh1 Idh2 Jak2 Kit Kras Mll Notch1 Npm1 Nras) Interrogation For Sequence Variants And Copy Number Variants Or Rearrangements Or Isoform Expression Or Mrna Expression Levels If Performed; Dna Analysis Or Combined Dna And Rna Analysis (Desc Rvsd 1/1/23) |
| 81451-CPT | Moderate | Targeted Genomic Sequence Analysis Panel, Hematolymphoid Neoplasm Or Disorder, 5-50 Genes (Eg, Braf, Cebpa, Dnmt3a, Ezh2, Flt3, Idh1, Idh2, Jak2, Kit, Kras, Mll, Notch1, Npm1, Nras), Interrogation For Sequence Variants, And Copy Number Variants Or Rearrangements, Or Isoform Expression Or Mrna Expression Levels, If Performed; Rna Analysis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81449. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81449 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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