CPT 81500 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81500 |
| Medicaid Fee Schedule | View Medicaid rates for 81500 |
National average reimbursement for CPT 81500 by major payers:
$200.20
$159.55
$241.96
$381.73
CPT 81500 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81500 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 81500 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 |
|---|---|---|
| 81500-CPT | Moderate | Oncology (Ovarian) Biochemica, Oncology (Ovarian) Biochemical Assays Of Two Proteins (Ca-125 And He4) Utilizing Serum With Menopausal Status Algorithm Reported As A Risk Score [Roma] |
| 81503-CPT | Moderate | Oncology (Ovarian) Biochemica, Oncology (Ovarian) Biochemical Assays Of Five Proteins (Ca-125 Apoliproprotein A1 Beta-2 Microglobulin Transferrin And Pre-Albumin) Utilizing Serum Algorithm Reported As A Risk Score [Ova1] |
| 81504-CPT | Moderate | Oncology Tissue Of Origin, Oncology Tissue Of Origin Microarray Gene Expression Profiling Of 2000 Genes Utilizing Formalin Fixed Paraffin Embedded Tissue Algorithm Reported As Tissue Similarity Scores |
| 81506-CPT | Low | Endo Assay Seven Anal, 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81500 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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