How much does Medicare pay for CPT 81189?

Medicare allowed an average of $269.32 per service and paid $269.32 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $412.49, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81189?

Gene analysis (cystatin b) of full sequence. It was billed 21,554 times to 21,538 Medicare beneficiaries by 41 providers in 2024.

Which specialty bills 81189 most?

Clinical Laboratory, with 21,554 services from 41 clinicians.

CPT 81189

Gene analysis (cystatin b) of full sequence

$269.32Medicare-allowed amount per service, averaged across 21,554 services

Providers submitted

$412.49

Asking price, not received

Medicare allowed

$269.32

The fee schedule figure

Medicare paid

$269.32

Balance is patient coinsurance

Providers submitted an average of $412.49 for this code and Medicare allowed $269.32 — 1.5× 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 $269.32 (100%); the rest is the patient’s coinsurance and deductible.

Services: 21,554
Beneficiaries: 21,538
Providers billing it: 41
Total allowed: $5,804,923

What Medicare pays for CPT 81189

Across 21,554 services billed by 41 providers to 21,538 beneficiaries, Medicare allowed an average of $269.32 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 81189

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	21,554	21,538	$269.32	41

81189 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	10,006	$269.31	$269.33	17
New Jersey	3,311	$269.33	$269.33	3
Pennsylvania	3,302	$269.33	$269.33	2
Florida	3,105	$269.33	$269.33	9
Colorado	1,027	$269.33	$269.33	1
Louisiana	487	$269.33	$269.33	3
Mississippi	144	$269.33	$269.33	2
Oklahoma	99	$269.33	$269.33	2
Arizona	39	$269.33	$269.33	1
Maryland	34	$269.33	$269.33	1

Related codes

81191Gene analysis (neurotrophic receptor tyrosine kinase 1) translocation$203.15
81192Gene analysis (neurotrophic receptor tyrosine kinase 2) translocation$203.16
81171Gene analysis (fragile x intellectual disability 2) for detection of a$134.21
81185Gene analysis (calcium voltage-gated channel subunit alpha1 a) of full$828.58
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.