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See a sample rate comparisonCPT 81513 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.
Nfct Ds Bv Rna Vag Flu Alg, Infectious Disease Bacterial Vaginosis Quantitative Real Time Amplification Of Rna Markers For Atopobium Vaginae Gardnerella Vaginalis And Lactobacillus Species Utilizing Vaginal Fluid Specimens Algorithm Reported As A Positive Or Negative Result For Bacterial Vaginosis
| 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 | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $142.63 national lab fee schedule rate (2026) · View Medicare rates for 81513 |
| Medicaid Fee Schedule | $133.00 median of the 8 states in the free preview · View Medicaid rates for 81513 |
National average reimbursement for CPT 81513 by major payers:
$124.98
$88.33
$133.45
$217.86
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CPT 81513
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$313.79Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$142.63Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$105.18Published rateHans Henriquez
Progressive Medical Center, S.C.
$78.44Published rateMolly Mcintosh
Baycare Medical Group Inc
$59.90Published rate
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See a sample payer proposalCPT 81513 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81513 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 81513 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 |
| 81513-CPT | Low | Nfct Ds Bv Rna Vag Flu Alg, Infectious Disease Bacterial Vaginosis Quantitative Real Time Amplification Of Rna Markers For Atopobium Vaginae Gardnerella Vaginalis And Lactobacillus Species Utilizing Vaginal Fluid Specimens Algorithm Reported As A Positive Or Negative Result For Bacterial Vaginosis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81513. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81513 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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Frequently Asked Questions
A Current Procedural Terminology (CPT) code is a five-digit numerical code used by medical professionals to report medical, surgical, and diagnostic services to entities such as physicians, health insurance companies, and accreditation organizations. These codes standardize the reporting of healthcare services, simplifying the billing and claims process.
To find the estimated cost of a medical procedure based on its CPT code and your specific location, you can utilize specialized tools. Payerprice offers a fee schedule lookup tool designed for this purpose, allowing you to search efficiently. For your exact out-of-pocket expenses, always consult with your insurance provider, as costs will vary based on your specific plan, deductible, and coverage.
A medical fee schedule is a comprehensive list of fees used by health plans and other payers to determine the maximum dollar amount they will pay for various medical services or procedures. These schedules are typically based on CPT (Current Procedural Terminology) codes and are crucial for understanding reimbursement rates for healthcare providers.
To compare specific procedure costs, especially for different providers or in various locations, a tool like Payerprice can be very beneficial. Payerprice provides a fee schedule lookup tool where you can input the CPT code and location to get relevant cost data. For personalized cost estimates that account for your insurance, it's always best to contact your insurance provider and the healthcare facility directly.