CPT 81539 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 • 99 - Other Place of Service |
| Common Modifiers | • None • 90 - Reference Laboratory • GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary |
| Complexity Level | Moderate |
National average reimbursement for CPT 81539 by major payers:
$635.20
$423.47
$672.80
$1,105.71
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 81539 | ||||||
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CPT 81539 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81539 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 81539 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 | Moderate | Oncology (Gynecologic) Liver Tumor Cell Culture And Chemotherapeutic Response By Dapi Stain And Morphology Predictive Algorithm Reported As A Drug Response Score; First Single Drug Or Drug Combination. |
| 81536 | Low | Oncology (Gynecologic) Liver 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 | High | Oncology (Lung) Mass Spectrometric 8-Protein Signature Including Amyloid A Utilizing Serum Prognostic And Predictive Algorithm Reported As Good Versus Poor Overall Survival. |
| 81539 | Moderate | 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 81539. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81539 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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