CPT 81490 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 • Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | • 81 - Independent Laboratory • 11 - Office |
| Common Modifiers | • None • 90 - Reference Laboratory • 26 - Professional component |
| Complexity Level | Moderate |
National average reimbursement for CPT 81490 by major payers:
$655.32
$447.65
$739.97
$1,235.72
| 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 81490 | ||||||
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CPT 81490 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81490 code is part of the Pathology and Laboratory Procedures services used for Multianalyte Assays with Algorithmic Analyses. 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 81490 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 |
|---|---|---|
| 81490 | Moderate | Autoimmune (Rheumatoid Arthritis) Analysis Of 12 Biomarkers Using Immunoassays Utilizing Serum Prognosticalgorithm Reported As A Disease Activity Score |
| 81493 | Moderate | Coronary Artery Disease, Mrna, Gene Expression Profiling By Real-Time Rt-Pcr Of 23 Genes, Utilizing Whole Peripheral Blood, Algorithm Reported As A Risk Score |
| 81506 | Low | Endocrinology (Type 2 Diabetes), Biochemical Assays Of Seven Analytes (Glucose, Hba1c, Insulin, Hs-Crp, Adiponectin, Ferritin, Interleukin 2-Receptor Alpha), Utilizing Serum Or Plasma, Algorithm Reporting A Risk Score |
| 81507 | Moderate | Fetal Aneuploidy (Trisomy 21 18 And 13) Dna Sequence Analysis Of Selected Regions Using Maternal Plasma Algorithm Reported As A Risk Score For Each Trisomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81490 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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