How much does Medicare pay for CPT 81455?

Medicare allowed an average of $2857.03 per service and paid $2857.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7064.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Which specialty bills 81455 most?

Clinical Laboratory, with 10,364 services from 25 clinicians. Next are Pathology.

CPT 81455

Genomic sequence analysis panel of dna or combined dna and rna of 51 or more genes associated with blood and lymphatic system disorders

$2857.03Medicare-allowed amount per service, averaged across 13,733 services

Providers submitted

$7064.54

Asking price, not received

Medicare allowed

$2857.03

The fee schedule figure

Medicare paid

$2857.03

Balance is patient coinsurance

Providers submitted an average of $7064.54 for this code and Medicare allowed $2857.03 — 2.5× 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 $2857.03 (100%); the rest is the patient’s coinsurance and deductible.

Services: 13,733
Beneficiaries: 12,857
Providers billing it: 30
Total allowed: $39,235,593

What Medicare pays for CPT 81455

Across 13,733 services billed by 30 providers to 12,857 beneficiaries, Medicare allowed an average of $2857.03 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 81455

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	10,364	9,574	$2856.02	25
Pathology	3,369	3,283	$2860.13	5

81455 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	5,436	$2855.43	$2861.21	7
New Jersey	3,277	$2861.67	$2861.21	4
Illinois	3,203	$2856.58	$2861.21	1
Massachusetts	726	$2861.21	$2861.21	1
Colorado	443	$2858.62	$2861.21	2
Maryland	194	$2861.21	$2861.21	2
Pennsylvania	134	$2861.21	$2861.21	1
Connecticut	84	$2861.21	$2861.21	1
New York	71	$2861.21	$2861.21	3
Oklahoma	63	$2855.41	$2861.21	2
Texas	57	$2763.29	$2813.48	3
New Mexico	21	$2626.57	$2861.21	1
Louisiana	12	$2861.21	$2861.21	1
Georgia	12	$2802.90	$2861.21	1

Related codes

81479Molecular pathology procedure$2459.22
81419Gene analysis panel for evaluation of genes associated$2399.59
81443Genomic sequence analysis panel for severe inherited conditions$2399.06
81440Test for detecting genes$3255.53
81448Gene analysis panel for hereditary disorders of the peripheral nervous$573.13
81450Genomic sequence analysis panel of dna or combined dna and rna of 5-50$740.49
81490Test for detecting genes associated$823.71
81418Genomic sequence analysis panel of at least 6 genes associated$898.48
81400Molecular pathology procedure level 1$62.67
81445Genomic sequence analysis panel of dna or combined dna and rna of 5-50$584.49
81401Molecular pathology procedure level 2$134.16

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.