CPT 81512 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 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81512 |
| Medicaid Fee Schedule | View Medicaid rates for 81512 |
National average reimbursement for CPT 81512 by major payers:
$57.67
$42.58
$115.69
$118.98
CPT 81512 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81512 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 81512 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 81512. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81512 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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