CPT 80055 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 | • Pathology and Laboratory Procedures • Organ or Disease Oriented Panels |
| Common Place of Service | • 81 - Independent Laboratory • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • 90 - Reference Laboratory |
| Complexity Level | Low |
National average reimbursement for CPT 80055 by major payers:
$39.48
$31.84
$51.92
$69.90
| 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 80055 | ||||||
United | 80055 | $47.81 | 1679678767 - MATAGORDA COUNTY HOSPITAL DISTRICT, MATAGORDA REGIONAL MEDICAL CENTER | 746025069 - (TX) MATAGORDA COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $57.36 | 1174526529 - TITUS COUNTY HOSPITAL DISTRICT, TITUS REGIONAL MEDICAL CENTER | 756003935 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1093744187 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS, MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL | 741303720 - BAPTIST HOSPITALS OF SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1841237807 - CHCA MAINLAND, L.P., MAINLAND MEDICAL CENTER | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1023065794 - CHCA WOMANS HOSPITAL LP, WOMAN'S HOSPITAL OF TEXAS | 621810381 - (TX) CHCA WOMANS HOSPITAL LP | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $63.22 | 1124078563 - TEMPLE VAMC, WACO VAMC | 742791419 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $26.54 | 1003192311 - EL CAMPO MEMORIAL HOSPITAL | 452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1740450121 - HOUSTON NORTHWEST OPERATING COMPANY, LLC, HOUSTON NORTHWEST MEDICAL CENTER ACUTE | 261512163 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1114473329 - EMERUS BHS SA THOUSAND OAKS LLC, BAPTIST NEIGHBORHOOD HOSPITAL SHAVANO PARK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $134.44 | 1124052162 - CITIZENS MEDICAL CENTER COUNTY OF VICTORIA, COUNTY OF VICTORIA CITIZENS MEDICAL CENTER | 741698143 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1306897277 - COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP, MEDICAL CITY DENTON | 621682213 - (TX) COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $53.90 | 1588648315 - POINTE COUPEE PARISH HEALTH SERVICES DISTRICT NUMBER ONE, POINTE COUPEE GENERAL HOSPITAL | 721054801 | LA | Critical Access Hospital (282NC0060X) |
United | 80055 | $47.81 | 1588631311 - SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC, SURGICAL SPECIALTY CENTER OF BATON ROUGE | 263120962 - (LA) SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC | LA | 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 80055 vs. Other Organ or Disease Oriented Panels Codes
The CPT 80055 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 80055 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 |
|---|---|---|
| 80055-CPT | Low | Obstetric Panel. Must Include The Following: Blood Count Complete (Cbc) Automated And Automated Differential Wbc Count (85025 Or 85027 And85004); O R Blood Count Complete (Cbc) Automated(85027) A Nd Appropriate Manual Differential Wbc Count (85007 Or 85009); Hepatitis B Surface Antigen (Hbsag)(87340); Antibody Rubella (86762); Syphilis Test Qualitative (Eg Vdrl Rpr Art)(86592); Antibody Screen Rbc Each Serum Technique (86850); Blood Typing Abo (86900); And Blood Typing Rh |
| 80081-CPT | Low | Obstetric Panel (Includes Hiv Testing) This Panel Must Include The Following: Blood Count, Complete (Cbc), And Automated Differential Wbc Count (85025 Or 85027 And 85004) Or Blood Count, Complete (Cbc), Automated (85027) And Appropriate Manual Differential Wbc Coun |
| 86592-CPT | Low | Syphilis Test, Non-Treponemal Antibody; Qualitative (Eg, Vdrl, Rpr, Art) |
| 86762-CPT | Low | Antibody Rubella |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80055. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80055 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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