CPT 88249 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 • Cytogenetic Studies |
| Common Place of Service | • 81 - Independent Laboratory • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 90 - Reference Laboratory • 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88249 |
National average reimbursement for CPT 88249 by major payers:
$172.02
$165.02
$189.68
$257.49
| 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 88249 | ||||||
United | 88249 | $194.43 | 1033320049 - ANN STECK | 344428256 - TOLEDO HOSPITAL | OH | Family Medicine Physician (207Q00000X) |
United | 88249 | $418.03 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 88249 | $96.77 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 88249 | $103.90 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | 88249 | $329.94 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88249 | $40.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 88249 | $55.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 88249 | $103.90 | 1609005479 - WILLIAM YANG | 953841576 - (CA) RENAL CONSULTANTS MEDICAL GROUP | CA | Nephrology Physician (207RN0300X) |
United | 88249 | $173.17 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88249 | $55.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 88249 | $155.85 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 88249 | $291.95 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 88249 | $249.36 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 88249 | $103.90 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 88249 | $380.97 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
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 88249 vs. Other Cytogenetic Studies Codes
The CPT 88249 code is part of the Pathology and Laboratory Procedures services used for Cytogenetic Studies. 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 88249 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 |
|---|---|---|
| 88241-CPT | Low | Thawing And Expansion Of Frozen Cells Each Aliquot |
| 88245-CPT | Low | Chromosome Analysis For Breakage Syndromes; Score 25 Cells (Sce Study), Count 5 Cells, 1 Karyotype, With Banding (Eg, Bl |
| 88248-CPT | Low | Chromosome Analysis For Breakage Syndromes; Baseline Breakage, Score 50-100 Cells, Count 20 Cells, 2 Karyotypes (Eg, For Ataxia Telangiectasia, Fanconi Anemia, Fragile X) |
| 88249-CPT | Low | Chromosome Analysis For Breakage Syndromes; Score 100 Cells, Clastogen Stress (Eg, Diepoxybutane, Mitomycin C, Ionizing Radiation, Uv Radiation) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88249. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88249 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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