CPT 81455 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 90 - Reference Laboratory • 26 - Professional component |
| Complexity Level | High |
National average reimbursement for CPT 81455 by major payers:
$2,154.97
$1,788.49
$2,654.06
$4,226.45
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 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 | 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 | 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 | 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 | 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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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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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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