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See a sample rate comparisonCPT 81503 Fee Schedule
Last Verified: October 2026
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.
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]
| 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 | 90 - Reference Laboratory TC - Technical component GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $897.00 national lab fee schedule rate (2026) · View Medicare rates for 81503 |
| Medicaid Fee Schedule | $897.00 median of the 7 states in the free preview · View Medicaid rates for 81503 |
National average reimbursement for CPT 81503 by major payers:
$662.18
$549.36
$799.41
$1,258.69
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CPT 81503
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,973.40Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$897.00Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$661.47Published rateChristopher Raio
St Joseph Hospital
$484.38Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$358.79Published rate
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See a sample payer proposalCPT 81503 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81503 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 81503 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 81503. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81503 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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