How much does Medicare pay for CPT 81223?

Medicare allowed an average of $472.59 per service and paid $472.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $600.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81223?

Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence. It was billed 45,033 times to 44,986 Medicare beneficiaries by 78 providers in 2024.

Which specialty bills 81223 most?

Clinical Laboratory, with 44,973 services from 74 clinicians. Next are Pain Management, Physical Medicine and Rehabilitation, Internal Medicine.

CPT 81223

Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence

$472.59Medicare-allowed amount per service, averaged across 45,033 services

Providers submitted

$600.77

Asking price, not received

Medicare allowed

$472.59

The fee schedule figure

Medicare paid

$472.59

Balance is patient coinsurance

Providers submitted an average of $600.77 for this code and Medicare allowed $472.59 — 1.3× 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 $472.59 (100%); the rest is the patient’s coinsurance and deductible.

Services: 45,033
Beneficiaries: 44,986
Providers billing it: 78
Total allowed: $21,282,145

What Medicare pays for CPT 81223

Across 45,033 services billed by 78 providers to 44,986 beneficiaries, Medicare allowed an average of $472.59 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 81223

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	44,973	44,926	$472.57	74
Pain Management	28	28	$489.02	2
Physical Medicine and Rehabilitation	20	20	$489.02	1
Internal Medicine	12	12	$489.02	1

81223 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
Florida	24,648	$472.50	$488.37	27
Texas	9,645	$461.39	$488.92	29
New Jersey	6,559	$489.02	$489.02	6
Pennsylvania	2,658	$489.02	$489.02	3
Colorado	842	$411.60	$489.02	1
Louisiana	355	$489.02	$489.02	4
Oklahoma	160	$485.77	$489.02	2
Maryland	76	$483.10	$489.02	2
Mississippi	42	$484.93	$489.02	2
New York	32	$489.02	$489.02	1
Georgia	16	$489.02	$489.02	1

Related codes

81279Gene analysis (janus kinase 2) targeted sequence analysis$180.52
81249Gene analysis (glucose-6-phosphate dehydrogenase) full sequence analys$587.96
81238Gene analysis (coagulation factor ix) full sequence analysis$586.91
81209Gene analysis (bloom syndrome$38.52
81242Gene analysis (fanconi anemia$35.89
81256Gene analysis (hemochromatosis) common variants$64.01
81250Gene analysis (glucose-6-phosphatase$57.32
81291Gene analysis (5$64.03
81206Translocation analysis (bcr/abl1) major breakpoint$160.03
81298Gene analysis (muts homolog 6 [e coli]) full sequence analysis$628.63
81241Gene analysis (coagulation factor v) leiden variant$71.89
81243Gene analysis (fragile x syndrome$55.88

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.