What is Gene Analysis Prothrombin (CPT 81240)?

Gene analysis (prothrombin, coagulation factor ii) a variant. This clinical code is utilized across practices and hospitals for diagnostic and therapeutic service documentation.

What do doctors typically charge for Gene Analysis Prothrombin?

The nationwide median physician charge for Gene Analysis Prothrombin (CPT 81240) is $225.79. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 81240?

The standard insurance baseline reimbursement rate is $64.38. This represents the customary allowable amount established across standard fee schedules.

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CPT 81240Medical Service

Gene Analysis Prothrombin

Gene analysis (prothrombin, coagulation factor ii) a variant. Clinical pricing breakdown and utilization metrics across 42 practicing doctors nationwide.

$225.79

Peer Median Charge

Gross billed rate

$64.38

Standard Baseline

Customary allowable

3.5x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT 81240?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $225.79. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $64.38 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 81240 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"