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See a sample rate comparisonCPT 81522 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.
Onc Breast Mrna 12 Genes, Oncology Breast Mrna Gene Expression Profiling By Rt Pcr Of 12 Genes 8 Content And 4 Housekeeping Utilizing Formalin Fixed Paraffin Embedded Tissue Algorithm Reported As Recurrence Risk Score
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | GY - Notice of Liability Not Issued, Not Required Under Payer Policy. GA - Required ABN issued and on file |
| Complexity Level | High |
| Medicare Fee Schedule | $3,873.00 national lab fee schedule rate (2026) · View Medicare rates for 81522 |
| Medicaid Fee Schedule | $3,563.165 median of the 8 states in the free preview · View Medicaid rates for 81522 |
National average reimbursement for CPT 81522 by major payers:
$3,495.01
$2,363.79
$3,515.09
$5,492.75
Compare published rates across providers.
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CPT 81522
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$8,520.60Published rateChristopher Raio
St Francis Hospital
$4,601.12Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,873.00Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$2,323.80Published rateBaptist Health Care, Inc., Baptist Home Healt Care And Medical Equipment
Baptist Health Care Inc
$1,626.66Published rate
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See a sample payer proposalCPT 81522 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81522 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 81522 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) |
| 81522-CPT | High | Onc Breast Mrna 12 Genes, Oncology Breast Mrna Gene Expression Profiling By Rt Pcr Of 12 Genes 8 Content And 4 Housekeeping Utilizing Formalin Fixed Paraffin Embedded Tissue Algorithm Reported As Recurrence 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 81522. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81522 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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