CPT 81546 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Pathology and Laboratory Procedures • Multianalyte Assays with Algorithmic Analyses |
| Common Place of Service | • 81 - Independent Laboratory |
| Common Modifiers | • None • 59 - Distinct Procedural Service |
| Complexity Level | High |
National average reimbursement for CPT 81546 by major payers:
$3,323.37
$2,196.65
$3,298.12
$5,143.87
| 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 81546 | ||||||
United | 81546 | $1260.00 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 81546 | $2160.00 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $4752.00 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $3609.50 | 1497207146 - MELANIE SMITH | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Registered Dietitian (133V00000X) |
United | 81546 | $4752.00 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $3672.00 | 1184809220 - AHS HOSPITAL CORP | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Case Management Agency (251B00000X) |
United | 81546 | $3600.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81546 | $2160.00 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 81546 | $1944.00 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $7920.00 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81546 | $3596.40 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $1512.00 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81546 | $4752.00 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 81546 | $5400.00 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81546 | $1512.00 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81546 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81546 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 81546 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 |
|---|---|---|
| 81541-CPT | High | Oncology (Prostate) Mrna Gene Expression Profiling By Real-Time Rt-Pcr Of 46 Genes (31 Content And 15 Housekeeping) Utilizing Formalin- Fixed Paraffin Embedded Tissue Algorithm Reported As A Disease-Specific Mortality Risk Scor |
| 81542-CPT | High | Oncology (Prostate) Mrna Microarray Gene Expression Profiling Of 22 Content Genes Utilizinformalin-Fixed Paraffin-Embedded Tissue Algorithm Reported As Metastasis Risk Score |
| 81546-CPT | High | Oncology (Thyroid) Mrna Gene Expression Analysis Of 10 196 Genes Utilizing Fine Needle Aspirate Algorithm Reported As A Categorical Result (Eg Benign Or Suspicious) |
| 81551-CPT | High | Oncology (Prostate) Promoter Methylation Profiling By Real-Time Pcr Of 3 Genes (Gstp1 Apc Rassf1) Utilizing Formalin-Fixed Paraffin Embedded Tissue Algorithm Reported As A Likelihood Of Prostate Cancer Detection On Repeat Biopsy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81546. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81546 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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