CPT 0078U Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Proprietary Laboratory Analyses |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 0078U |
National average reimbursement for CPT 0078U by major payers:
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| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 0078U | ||||||
United | 0078U | $405.82 | 1497792527 - UNIVERSITY HEALTHCARE SYSTEM, L.C., TULANE LAKESIDE HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1831975572 - DECATUR HEALTH SERVICES, LLC | 932081386 | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1184911877 - VHS BROWNSVILLE HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER - BROWNSVILLE | 452663071 | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1679528889 - ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, ST. DAVID'S SOUTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $992.00 | 1073502985 - CHU CHEN | 42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 0078U | $541.09 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1871911016 - NORTH TEXAS, MEDICAL CITY ALLIANCE | 464027347 - (TX) NORTH TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $405.82 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1902857766 - COLUMBIA MEDICAL CENTER OF LAS COLINAS INC, MEDICAL CITY LAS COLINAS | 621650582 - (TX) COLUMBIA MEDICAL CENTER OF LAS COLINAS INC | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1902857766 - COLUMBIA MEDICAL CENTER OF LAS COLINAS INC, MEDICAL CITY LAS COLINAS | 621650582 - (TX) COLUMBIA MEDICAL CENTER OF LAS COLINAS INC | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 0078U | $189.38 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 0078U | $450.91 | 1750819025 - NORTH HOUSTON, HCA HOUSTON HEALTHCARE TOMBALL | 821349955 | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 0078U vs. Other Proprietary Laboratory Analyses Codes
The CPT 0078U code is part of the Proprietary Laboratory Analyses services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 0078U code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 0078U-CPT | Moderate | Pain Management (Opioid-Use Disorder) Genotyping Panel, 16 Common Variants (Ie, Abcb1, Comt, Dat1, Dbh, Dor, Drd1, Drd2, Drd4, Gaba, Gal, Htr2a, Httlpr, Mthfr, Muor, Oprk1, Oprm1), Buccal Swab Or Other Germline Tissue Sample, Algorithm Reported As Positive Or Negative Risk Of Opioid-Use Disorder |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 0078U. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 0078U fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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