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See a sample rate comparisonCPT 81455 Fee Schedule
Last Verified: October 2026
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.
Targeted Genomic Sequence Analysis Panel Solid Organ Or Hematolymphoid Neoplasm Or Disorder 51 Or Greater Genes (Eg Alk Braf Cdkn2a Cebpa Dnmt3a Egfr Erbb2 Ezh2 Flt3 Idh1 Idh2 Jak2 Kit Kras Met Mll Notch1 Npm1 Nras Pdgfra Pdgfrb Pgr Pik3ca Pten Ret) Tch1 Pdgfra Pdgfrbpgr Pik3ca Pten Ret) Interrogation For Sequence Variants And Copy Number Variants Or Rearrangements Or Isoform Expression Or Mrna Expression Levels If Performed; Dna Analysis Or(Desc Rvsd 1/1/23)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Genomic Sequencing Procedures and Other Molecular Multianalyte Assays |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | High |
| Medicare Fee Schedule | $2,919.60 national lab fee schedule rate (2026) · View Medicare rates for 81455 |
| Medicaid Fee Schedule | $2,744.425 median of the 8 states in the free preview · View Medicaid rates for 81455 |
National average reimbursement for CPT 81455 by major payers:
$2,154.97
$1,788.49
$2,654.06
$4,136.38
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CPT 81455
5 of 25 sample ratesHigher to lower in this preview
Laboratory Corporation Of America Holdings
$3,864.53Published rateLaboratory Corporation Of America
$2,780.36Published rateLaboratory Corporation Of America Holdings
$2,746.03Published rateAssociated Pathologists Laboratory PA
$1,751.76Published rateSeacoast Pathology Inc
$1,167.83Published rate
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See a sample payer proposalCPT 81455 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81455 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 81455 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 | Tgsap So Neo 5 50 Rna Alys, 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) |
| 81455-CPT | High | Targeted Genomic Sequence Analysis Panel Solid Organ Or Hematolymphoid Neoplasm Or Disorder 51 Or Greater Genes (Eg Alk Braf Cdkn2a Cebpa Dnmt3a Egfr Erbb2 Ezh2 Flt3 Idh1 Idh2 Jak2 Kit Kras Met Mll Notch1 Npm1 Nras Pdgfra Pdgfrb Pgr Pik3ca Pten Ret) Tch1 Pdgfra Pdgfrbpgr Pik3ca Pten Ret) Interrogation For Sequence Variants And Copy Number Variants Or Rearrangements Or Isoform Expression Or Mrna Expression Levels If Performed; Dna Analysis Or(Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81455. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81455 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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Frequently Asked Questions
To find out the cost of a medical procedure, you can start by contacting your healthcare provider's billing department for an estimate. For a more detailed and comparable estimate based on specific CPT codes and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search for procedure costs using CPT codes and specific geographical areas. It's also advisable to contact your insurance company to understand your coverage and potential out-of-pocket expenses.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are crucial for understanding medical costs because they provide a standardized way for reporting services to insurers and for billing. When you know the CPT code for a specific procedure, you can use it to search for pricing information, such as with Payerprice's fee schedule lookup tool, and to discuss expected costs accurately with your insurer or provider.
No, medical prices are generally not the same across all providers, even for the same service within the same geographical area. Prices can vary significantly based on factors such as the healthcare facility's type (e.g., hospital vs. independent clinic), their negotiated rates with different insurance companies, geographical location, provider specialty, and facility overheads. This variability makes it important to research and compare costs, and tools like Payerprice can assist in finding price ranges based on CPT codes and location.
To compare prices for a specific medical service in your area, you can first ask your provider for the CPT code of the service. Once you have the CPT code, you can use online tools specifically designed for price comparison. Payerprice offers a fee schedule lookup tool that allows you to search for expected costs using the CPT code and your specific location, providing a valuable resource for comparing prices among different providers or facilities. Additionally, you can contact multiple providers directly for estimates and check with your insurance company for in-network pricing.
Several resources can help you estimate your out-of-pocket medical costs. Your health insurance company is a primary resource, as they can provide details on your deductible, co-pays, co-insurance, and out-of-pocket maximums for specific services. For procedure-specific cost estimates, you can ask your provider for the CPT code and then use tools like Payerprice. Payerprice's fee schedule lookup tool allows you to search for the cost of services by CPT code and location, which can help you anticipate the bill before insurance adjustments. Many hospitals and clinics also offer price estimators or financial counselors to help patients understand potential costs.