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See a sample rate comparisonCPT 81509 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.
Ftl Cgen Abnor 3 Proteins, Fetal Congenital Abnormalities Biochemical Assays Of Three Proteins Papp A Hcg Any Form Dia Utilizing Maternal Serum Algorithm Reported As A Risk Score
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Complexity Level | High |
| Medicare Fee Schedule | $1,487.37 national lab fee schedule rate (2026) · View Medicare rates for 81509 |
| Medicaid Fee Schedule | $1,487.37 median of the 7 states in the free preview · View Medicaid rates for 81509 |
National average reimbursement for CPT 81509 by major payers:
$1,136.08
$910.89
$1,260.79
$2,072.88
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CPT 81509
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,272.21Published rateChristopher Raio
St Francis Hospital
$1,767.00Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$1,096.84Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$892.42Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$594.95Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81509 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81509 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 81509 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 |
|---|---|---|
| 81509-CPT | High | Ftl Cgen Abnor 3 Proteins, Fetal Congenital Abnormalities Biochemical Assays Of Three Proteins Papp A Hcg Any Form Dia Utilizing Maternal Serum Algorithm Reported As A Risk Score |
| 81510-CPT | Low | Ftl Cgen Abnor Three Anal, Fetal Congenital Abnormalities Biochemical Assays Of Three Analytes Afp Ue3 Hcg Any Form Utilizing Maternal Serum Algorithm Reported As A Risk Score |
| 81511-CPT | Low | Ftl Cgen Abnor Four Anal, Fetal Congenital Abnormalities Biochemical Assays Of Four Analytes Afp Ue3 Hcg Any Form Dia Utilizing Maternal Serum Algorithm Reported As A Risk Score May Include Additional Results From Previous Biochemical Testing |
| 81512-CPT | Low | Ftl Cgen Abnor Five Anal, Fetal Congenital Abnormalities Biochemical Assays Of Five Analytes Afp Ue3 Total Hcg Hyperglycosylated Hcg Dia Utilizing Maternal Serum Algorithm Reported As 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 81509. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81509 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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