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See a sample rate comparisonCPT 80050 Fee Schedule
Last Verified: October 2026
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.
General Health Panel, General Health Panel This Panel Must Include The Following Comprehensive Metabolic Panel 80053 Blood Count Complete Cbc Automated And Automated Differential Wbc Count 85025 Or 85027 And 85004 Or Blood Count Complete Cbc Automated 85027 And Appropriate Manual Differential Wbc Count 85007 Or 85009 Thyroid Stimulating Hormone Tsh 84443
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Organ or Disease Oriented Panels |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80050 |
| Medicaid Fee Schedule | $36.44 median of the 8 states in the free preview · View Medicaid rates for 80050 |
National average reimbursement for CPT 80050 by major payers:
$36.02
$26.95
$41.64
$549.18
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CPT 80050
5 of 25 sample ratesHigher to lower in this preview
Sardar Shah-Khan
Monongalia County General Hospital Company
$66.41Published rateGeorge Pavlou
Gastroenterology Associates Of New Jersey, LLC
$33.75Published rateArun Mathew
Rf Ledon Md PC
$30.37Published rateJohn Sotiriadis
Gastroenterology Associates Of New Jersey, LLC
$30.37Published rateKavan Patel
Seton Family Of Doctors
$19.86Published rate
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See a sample payer proposalCPT 80050 vs. Other Organ or Disease Oriented Panels Codes
The CPT 80050 code is part of the Pathology and Laboratory Procedures services used for Organ or Disease Oriented Panels. 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 80050 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 |
|---|---|---|
| 80050-CPT | Low | General Health Panel, General Health Panel This Panel Must Include The Following Comprehensive Metabolic Panel 80053 Blood Count Complete Cbc Automated And Automated Differential Wbc Count 85025 Or 85027 And 85004 Or Blood Count Complete Cbc Automated 85027 And Appropriate Manual Differential Wbc Count 85007 Or 85009 Thyroid Stimulating Hormone Tsh 84443 |
| 80053-CPT | Low | Comprehen Metabolic Panel, Comprehensive Metabolic Panel This Panel Must Include The Following Albumin 82040 Bilirubin Total 82247 Calcium Total 82310 Carbon Dioxide Bicarbonate 82374 Chloride 82435 Creatinine 82565 Glucose 82947 Phosphatase Alkaline 84075 Potassium 84132 Protein Total 84155 Sodium 84295 Transferase Alanine Amino Alt Sgpt 84460 Transferase Aspartate Amino Ast Sgot 84450 Urea Nitrogen Bun 84520 |
| 85025-CPT | Low | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. |
| 85027-CPT | Low | Complete Blood Count (Cbc), A Complete Blood Count Includes Red Blood Cells White Blood Cells Hemoglobin Hematocrit Platelets And Distribution Of The Cells Within The Blood Volume Sampled. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80050. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80050 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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Frequently Asked Questions
To get an estimate for a specific medical procedure, you'll often need the CPT (Current Procedural Terminology) code. Once you have this code, you can use tools that provide fee schedule lookups. For detailed information specific to your location and the CPT code, you can use Payerprice's fee schedule lookup tool. They allow users to search with CPT codes and specific locations to help you understand potential costs. It's also advisable to contact your insurance provider directly for coverage details.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to describe medical, surgical, and diagnostic services. They are crucial for standardizing the billing process between healthcare providers and insurance companies. CPT codes ensure that both parties understand exactly what services were rendered, allowing for proper processing of claims and determining reimbursement rates.
To determine if a specific medical procedure is covered by your insurance, the best approach is to contact your insurance provider directly. You can typically find their customer service number on your insurance card or their official website. Be prepared to provide the CPT code for the procedure, if available, as this will help them provide the most accurate information regarding your benefits, coverage, and any out-of-pocket costs you might incur.
These are common terms related to your out-of-pocket costs for healthcare: * **Co-pay (or Copayment):** A fixed amount you pay for a covered healthcare service at the time you receive the service. For example, $20 for a doctor's visit. * **Deductible:** The amount you must pay for healthcare services each year before your insurance company begins to pay. For example, if your deductible is $1,000, you pay the first $1,000 of covered services yourself. * **Co-insurance:** Your share of the cost of a healthcare service after you've paid your deductible. It's usually a percentage. For example, if your co-insurance is 20%, your insurance pays 80% and you pay 20% of the bill once your deductible is met.
The variation in prices for the same medical service across different providers can be attributed to several factors. These include differences in negotiated rates with insurance companies, the cost of operating a facility (e.g., hospital vs. independent clinic), geographic location, the technology or equipment used, the expertise of the providers, and even differences in overhead costs. Providers also have varying pricing strategies and market dynamics can play a role. To compare costs, obtaining the CPT code and checking tools like Payerprice can be helpful.