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See a sample rate comparisonCPT 81521 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.
Oncology (Breast) Mrna Micro, Oncology (Breast) Mrna Microarray Gene Expression Profiling Of 70 Content Genes And 465 Housekeeping Genes Utilizing Fresh Frozen Or Formalin-Fixedparaffin-Embedded Tissue Algorithm Reported As I Ndex Related To Risk Of Distant Metastasis Hpa-9ab (V837m)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | 59 - Distinct Procedural Service GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | High |
| Medicare Fee Schedule | $3,873.00 national lab fee schedule rate (2026) · View Medicare rates for 81521 |
| Medicaid Fee Schedule | $3,834.27 median of the 8 states in the free preview · View Medicaid rates for 81521 |
National average reimbursement for CPT 81521 by major payers:
$2,960.79
$2,364.18
$3,546.83
$5,534.19
Compare published rates across providers.
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CPT 81521
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$8,520.60Published rateAshley O'Connor
Atlantic Health System Inc
$3,883.21Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$2,856.11Published rateMichael Shuler
Athens Orthopedic Clinic, P.A.
$2,323.80Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$1,549.19Published rate
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See a sample payer proposalCPT 81521 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81521 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 81521 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 |
|---|---|---|
| 81518-CPT | High | Onc Brst Mrna 11 Genes, Oncology Breast Mrna Gene Expression Profiling By Real Time Rt Pcr Of 11 Genes 7 Content And 4 Housekeeping Utilizing Formalin Fixed Paraffin Embedded Tissue Algorithms Reported As Percentage Risk For Metastatic Recurrence And Likelihood Of Benefit From Extended Endocrine Therapy |
| 81519-CPT | High | Oncology (Breast) Mrna Gene, Oncology (Breast) Mrna Gene Expression Profilingby Real-Time Rt-Pcr Of 21 Genes Utilizing Formal In-Fixed Paraffin-Embedded Tissue Algorithm Reported As Recurrence Score |
| 81520-CPT | High | Oncology (Breast) Mrna Gene E, Oncology (Breast) Mrna Gene Expression Profiling By Hybrid Capture Of 58 Genes (50 Content And 8 Housekeeping) Utilizing Formalin-Fixed Paraffin-Embedded Tissue Algorithm Reported As A Recurrence Risk Score Hpa-9ab (V837m) |
| 81521-CPT | High | Oncology (Breast) Mrna Micro, Oncology (Breast) Mrna Microarray Gene Expression Profiling Of 70 Content Genes And 465 Housekeeping Genes Utilizing Fresh Frozen Or Formalin-Fixedparaffin-Embedded Tissue Algorithm Reported As I Ndex Related To Risk Of Distant Metastasis Hpa-9ab (V837m) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81521. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81521 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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