CPT 81560 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 |
| Common Modifiers | 59 - Distinct Procedural Service None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 81560 |
| Medicaid Fee Schedule | View Medicaid rates for 81560 |
National average reimbursement for CPT 81560 by major payers:
$522.80
$391.19
$584.95
$978.69
CPT 81560 vs. Other Multianalyte Assays with Algorithmic Analyses Codes
The CPT 81560 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 81560 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 |
|---|---|---|
| 81560-CPT | Moderate | Trnsplj Pd Lvr Bwl Cd154 Cll, Transplantation Medicine Allograft Rejection Pediatric Liver And Small Bowel Measurement Of Donor And Third Party Induced Cd154 T Cytotoxic Memory Cells Utilizing Whole Peripheral Blood Algorithm Reported As A Rejection Risk Score |
| 81595-CPT | High | Cardiology Hrt Trnspl Mrna, Cardiology Heart Transplant Mrna Gene Expression Profiling By Real Time Quantitative Pcr Of 20 Genes 11 Content And 9 Housekeeping Utilizing Subfraction Of Peripheral Blood Algorithm Reported As A Rejection Risk Score |
| 81596-CPT | Low | Nfct Ds Chrnc Hcv 6 Assays, Infectious Disease Chronic Hepatitis C Virus Hcv Infection Six Biochemical Assays Alt A2 Macroglobulin Apolipoprotein A 1 Total Bilirubin Ggt And Haptoglobin Utilizing Serum Prognostic Algorithm Reported As Scores For Fibrosis And Necroinflammatory Activity In Liver |
| 81599-CPT | Moderate | Multiple Lab Test Analysis, A Mathematic Formula Is Used To Analyze A Variety Of Lab Test Results To Determine An Individuals Risk For Disease. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81560. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81560 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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