How much does Medicare pay for CPT 81500?

Medicare allowed an average of $256.18 per service and paid $198.92 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $550.99, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81500?

Genetic profiling on oncology biopsy of ovarian lesions, assays of two proteins. It was billed 1,072 times to 1,036 Medicare beneficiaries by 17 providers in 2024.

Which specialty bills 81500 most?

Clinical Laboratory, with 1,072 services from 17 clinicians.

CPT 81500

Genetic profiling on oncology biopsy of ovarian lesions, assays of two proteins

$256.18Medicare-allowed amount per service, averaged across 1,072 services

Providers submitted

$550.99

Asking price, not received

Medicare allowed

$256.18

The fee schedule figure

Medicare paid

$198.92

Balance is patient coinsurance

Providers submitted an average of $550.99 for this code and Medicare allowed $256.18 — 2.2× 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 $198.92 (78%); the rest is the patient’s coinsurance and deductible.

Services: 1,072
Beneficiaries: 1,036
Providers billing it: 17
Total allowed: $274,625

What Medicare pays for CPT 81500

Across 1,072 services billed by 17 providers to 1,036 beneficiaries, Medicare allowed an average of $256.18 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 81500

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	1,072	1,036	$256.18	17

81500 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
North Carolina	306	$256.53	$194.40	1
New Jersey	305	$255.73	$197.32	2
California	105	$256.45	$198.20	2
Arizona	82	$256.43	$199.46	2
Ohio	69	$256.54	$194.14	1
Florida	40	$255.29	$255.29	2
Alabama	39	$256.46	$197.74	1
Texas	36	$256.50	$195.87	2
Colorado	32	$255.04	$188.15	1
Louisiana	24	$256.56	$193.01	1
Georgia	21	$256.33	$204.23	1
Kansas	13	$255.29	$255.29	1

Related codes

81513Measurement of rna of bacteria in vaginal fluid specimen$138.72
81596Biochemical assays for evaluation of chronic hepatitis c virus infecti$70.65
81517Test for detecting 3 biomarkers associated$172.77
81514Measurement of dna of bacteria in vaginal fluid specimen$249.26

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.