CPT 81001 Medicare lab fee

Negotiated rates for 81001 vs Medicare Copy link

Commercial payers' negotiated rates for 81001 have medians of 70% to 110% of Medicare, depending on specialty.

Insurers must publish the rates they negotiate with in-network clinicians (the Transparency in Coverage rule). We reduce each file to medians by county and specialty and set them against Medicare's amount for the same place. Specialties that rarely or never perform a service are left out: contracts list a rate for nearly every code, including ones the group never bills.

Payers publish this data, and each dataset carries its month. A negotiated rate describes the contract, not the payment, and networks and plan designs vary. We publish a benchmark only when at least 10 providers from at least 5 separately contracting groups stand behind it (tax IDs that contract together, like a health system's, count as one group), and no single group accounts for more than 25% of it. Browse all payer benchmarks →

Global period: what 81001's fee already covers Copy link

The global surgery concept does not apply to this code.

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for 81001 →

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 19 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 2 units per patient per date of service.

Rate history by release Copy link

National Office (non-facility) amount for 81001 across quarterly releases.

How often 81001 is billed Copy link

Across Original Medicare in CY2024, 81001 ranked #42 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.6 times on average that year.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2026 fee schedule above.

Who bills 81001 to Medicare

Observed CY2024 Medicare fee-for-service billing, by the rendering clinician's CMS specialty. Each share is that specialty's slice of all observed services for this code that year.

Setting split that year: 100% Office (non-facility) · 0% facility. CMS publishes only this facility vs non-facility split, never the exact place of service. The Office (non-facility) figure does not identify urgent care or any other specific setting.

CY2024 Medicare fee-for-service only, from the CMS Physician & Other Practitioners dataset, which suppresses rows under 11 beneficiaries. We omit specialty groups with fewer than 30 observed clinicians, so the shares can fall short of 100%. Specialty and practice-type pages linked elsewhere on this page are curated code lists, not utilization claims.

Related codes Copy link

Codes near 81001 in the pathology and laboratory services group, with their national Q4 2026 amounts at GPCI 1.000. A dash means the release publishes no payable PFS amount in that setting.

Localis groups these codes for payment research. The grouping isn't the AMA's code families.