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See a sample rate comparisonCPT 81538 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 (Lung) Mass Spectrom, Oncology (Lung) Mass Spectrometric 8-Protein Signature Including Amyloid A Utilizing Serum Prognostic And Predictive Algorithm Reported As Good Versus Poor Overall Survival
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | 81 - Independent Laboratory |
| Complexity Level | High |
| Medicare Fee Schedule | $2,871.00 national lab fee schedule rate (2026) · View Medicare rates for 81538 |
| Medicaid Fee Schedule | $2,871.00 median of the 8 states in the free preview · View Medicaid rates for 81538 |
National average reimbursement for CPT 81538 by major payers:
$2,142.71
$1,558.45
$2,534.74
$4,151.84
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CPT 81538
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$6,316.20Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$3,410.75Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$2,871.00Published rateChristopher Raio
St Joseph Hospital
$1,550.34Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$893.25Published rate
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See a sample payer proposalCPT 81538 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81538 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 81538 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 |
|---|---|---|
| 81535-CPT | Moderate | Oncology (Gynecologic) Live T, Oncology (Gynecologic) Live Tumor Cell Culture And Chemotherapeutic Response By Dapi Stain And Morphology Predictive Algorithm Reported As A Drug Response Score First Single Drug Or Drug Combinatio |
| 81536-CPT | Low | Oncology Gynecologic, Oncology Gynecologic Live Tumor Cell Culture And Chemotherapeutic Response By Dapi Stain And Morphology Predictive Algorithm Reported As A Drug Response Score Each Additional Single Drug Or Drug Combination List Separately In Addition To Code For Primary Procedure |
| 81538-CPT | High | Oncology (Lung) Mass Spectrom, Oncology (Lung) Mass Spectrometric 8-Protein Signature Including Amyloid A Utilizing Serum Prognostic And Predictive Algorithm Reported As Good Versus Poor Overall Survival |
| 81539-CPT | Moderate | Oncology Prostate Prob Score, Oncology High Grade Prostate Cancer Biochemical Assay Of Four Proteins Total Psa Free Psa Intact Psa And Human Kallikrein 2 Hk2 Utilizing Plasma Or Serum Prognostic Algorithm Reported As A Probability Score |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81538 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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