How much does Medicare pay for CPT 81185?

Medicare allowed an average of $828.58 per service and paid $828.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $915.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81185?

Gene analysis (calcium voltage-gated channel subunit alpha1 a) of full sequence. It was billed 15,005 times to 14,973 Medicare beneficiaries by 37 providers in 2024.

Which specialty bills 81185 most?

Clinical Laboratory, with 15,005 services from 37 clinicians.

CPT 81185

Gene analysis (calcium voltage-gated channel subunit alpha1 a) of full sequence

$828.58Medicare-allowed amount per service, averaged across 15,005 services

Providers submitted

$915.83

Asking price, not received

Medicare allowed

$828.58

The fee schedule figure

Medicare paid

$828.58

Balance is patient coinsurance

Providers submitted an average of $915.83 for this code and Medicare allowed $828.58 — 1.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $828.58 (100%); the rest is the patient’s coinsurance and deductible.

Services: 15,005
Beneficiaries: 14,973
Providers billing it: 37
Total allowed: $12,432,843

What Medicare pays for CPT 81185

Across 15,005 services billed by 37 providers to 14,973 beneficiaries, Medicare allowed an average of $828.58 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 81185

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	15,005	14,973	$828.58	37

81185 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	7,874	$828.57	$828.93	16
Florida	3,288	$829.33	$829.34	9
New Jersey	1,221	$829.34	$829.34	2
Colorado	982	$828.45	$829.34	1
Pennsylvania	810	$829.34	$829.34	1
Louisiana	487	$829.34	$829.34	3
Maryland	131	$818.26	$823.38	1
Oklahoma	126	$823.12	$823.12	2
Mississippi	47	$783.25	$783.25	1
Arizona	39	$829.34	$829.34	1

Related codes

81191Gene analysis (neurotrophic receptor tyrosine kinase 1) translocation$203.15
81189Gene analysis (cystatin b) of full sequence$269.32
81192Gene analysis (neurotrophic receptor tyrosine kinase 2) translocation$203.16
81171Gene analysis (fragile x intellectual disability 2) for detection of a$134.21
81179Gene analysis (ataxin 2) for abnormal alleles$134.26
81181Gene analysis (ataxin 7) for abnormal alleles$134.20
81177Gene analysis (atropin 1) for abnormal alleles$134.19
81180Gene analysis (ataxin 3) for abnormal alleles$134.26
81178Gene analysis (ataxin 1) for abnormal alleles$134.24
81183Gene analysis (ataxin 10) for abnormal alleles$134.25
81182Gene analysis (ataxin 8 opposite strand [non-protein coding]) for abno$134.26
81162Gene analysis (breast cancer 1 and 2) of full sequence and analysis fo$1784.60

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.