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See a sample rate comparisonCPT 96041 Fee Schedule
Last Verified: October 2026
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.
Genetic Counseling Svc Ea 30, Medical Genetics And Genetic Counseling Services Each 30 Minutes Of Total Time Provided By The Genetic Counselor On The Date Of The Encounter
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Medical Genetics and Genetic Counseling Services |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96041 |
| Medicaid Fee Schedule | $43.69 median of the 8 states in the free preview · View Medicaid rates for 96041 |
National average reimbursement for CPT 96041 by major payers:
$65.91
$86.09
$103.56
$90.42
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CPT 96041
5 of 25 sample ratesHigher to lower in this preview
Kathryn Rooney
$170.63Published rateKelly Walker
$132.39Published rateMariel Scheinberg
$105.97Published rateMagdelene May
$74.40Published rateSophia Gill
$63.54Published rate
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See a sample payer proposalCPT 96041 vs. Other Medical Genetics and Genetic Counseling Services Codes
The CPT 96041 code is part of the Medicine Services and Procedures services used for Medical Genetics and Genetic Counseling Services. 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 96041 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 |
|---|---|---|
| 96041-CPT | Low | Genetic Counseling Svc Ea 30, Medical Genetics And Genetic Counseling Services Each 30 Minutes Of Total Time Provided By The Genetic Counselor On The Date Of The Encounter |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96041. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96041 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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Frequently Asked Questions
To understand the potential cost of a medical procedure, you should first discuss it with your healthcare provider. They can provide you with the relevant CPT (Current Procedural Terminology) codes for the services. Once you have the CPT code and your specific location, you can then use tools like Payerprice to search for a fee schedule lookup based on these details. This will help you get an estimate of what different payers or providers might charge. Additionally, contact your insurance company directly to understand your coverage, deductible, and out-of-pocket maximums.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare professionals to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they provide a universal language for billing and reporting. When you know the specific CPT code for a service, you can use it to research prices more accurately, whether through your insurance company, provider, or fee schedule lookup tools like Payerprice.
For a detailed breakdown of medical service fees tailored to your specific location, the most effective approach is to obtain the CPT codes for the services you need from your healthcare provider. With these codes and your location, you can then utilize platforms such as Payerprice, which offer a fee schedule lookup tool. This allows you to search for pricing information and compare costs for various medical procedures. Remember to also consult your insurance provider for your specific coverage details.
The variation in prices for the same medical service across different providers can be attributed to several factors. These include differences in operational costs (e.g., facility size, technology, staffing ratios), negotiated rates with various insurance companies, geographical location, the provider's reputation or specialization, and whether the provider is in-network or out-of-network for your specific insurance plan. Additionally, transparency in pricing can be challenging. For specific cost estimates based on CPT codes and location, you can utilize tools like Payerprice, but remember these are estimates and your final cost will depend on your insurance coverage.