CPT 81238
Gene analysis (coagulation factor ix) full sequence analysis
Asking price, not received
The fee schedule figure
Balance is patient coinsurance
Providers submitted an average of $733.17 for this code and Medicare allowed $586.91 — 1.2× 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 $586.91 (100%); the rest is the patient’s coinsurance and deductible.
- Services
- 45,130
- Beneficiaries
- 45,081
- Providers billing it
- 72
- Total allowed
- $26,487,248
Medicare Part B, 2024
Services × allowed amount
What Medicare pays for CPT 81238
Across 45,130 services billed by 72 providers to 45,081 beneficiaries, Medicare allowed an average of $586.91 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 81238
| Specialty | Services | Beneficiaries | Avg allowed | Providers |
|---|---|---|---|---|
| Clinical Laboratory | 45,118 | 45,069 | $586.91 | 71 |
| Internal Medicine | 12 | 12 | $588.00 | 1 |
81238 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 | 24,777 | $586.17 | $587.61 | 26 |
| Texas | 9,810 | $587.70 | $587.83 | 29 |
| New Jersey | 6,457 | $588.00 | $588.00 | 5 |
| Pennsylvania | 2,606 | $588.00 | $588.00 | 3 |
| Colorado | 865 | $588.00 | $588.00 | 1 |
| Louisiana | 352 | $588.00 | $588.00 | 4 |
| Oklahoma | 189 | $584.72 | $588.00 | 2 |
| Maryland | 46 | $588.00 | $588.00 | 1 |
| Mississippi | 28 | $569.58 | $569.58 | 1 |
Related codes
- 81279Gene analysis (janus kinase 2) targeted sequence analysis$180.52
- 81249Gene analysis (glucose-6-phosphate dehydrogenase) full sequence analys$587.96
- 81223Gene analysis (cystic fibrosis transmembrane conductance regular) full$472.59
- 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.