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 | Organ or Disease Oriented Panels Pathology and Laboratory Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80055 |
National average reimbursement for CPT 80055 by major payers:
$39.48
$31.84
$51.92
$68.09
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 80055 | $47.81 | 1093793408 - JACKSON PARISH HOSPITAL, JACKSON PARISH HOSPITAL | 720549907 | 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 | 80055 | $52.90 | 1689676835 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 80055 | $43.02 | 1205833241 - CLHG-WINN, LLC, WINN PARISH MEDICAL CENTER | 813465517 | LA | General Acute Care Hospital (282N00000X) |
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 | $24.79 | 1740453000 - GRAHAM REGIONAL MEDICAL CENTER, GRAHAM GENERAL HSOPITAL PHYSICIANS | 463113489 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1295723229 - ST FRANCIS MEDICAL CENTER, INC | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1821098286 - TOURO INFIRMARY | 720423659 - (LA) TOURO INFIRMARY | LA | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1275592131 - METHODIST HOSPITALS OF DALLAS, METHODIST CHARLTON MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1982604021 - GEORGETOWN MEMORIAL HOSPITAL, TIDELANDS GEORGETOWN MEMORIAL HOSPITAL | 570341194 - GEORGETOWN MEMORIAL HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 80055 | $20.00 | 1346611829 - AMARI THOMAS | 760273984 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1578568481 - SLIDELL MEMORIAL HOSPITAL, ST TAMMANY PARISH HOSPITAL SERVICE DISTRICT #2 | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 80055 | $24.69 | 1689655912 - NOCONA HOSPITAL DISTRICT, NOCONA GENERAL HOSPITAL | 751368648 | TX | General Acute Care Hospital (282N00000X) |
United | 80055 | $47.81 | 1508810573 - BAY AREA HEALTHCARE GROUP, LTD., CORPUS CHRISTI MEDICAL CENTER | 752387418 | TX | General Acute Care Hospital (282N00000X) |
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 | 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 Pathology and Laboratory Procedures Codes
The CPT 80055 code is part of the Organ or Disease Oriented Panels services used for Pathology and Laboratory Procedures. 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, Obstetric Panel This Panel Must Include The Following 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 Hepatitis B Surface Antigen Hbsag 87340 Antibody Rubella 86762 Syphilis Test Non Treponemal Antibody Qualitative Eg Vdrl Rpr Art 86592 Antibody Screen Rbc Each Serum Technique 86850 Blood Typing Abo 86900 And Blood Typing Rh D 86901 |
| 80081-CPT | Low | Obstetric Panel, 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 Count 85007 Or 85009 Hepatitis B Surface Antigen Hbsag 87340 Hiv 1 Antigen S With Hiv 1 And Hiv 2 Antibodies Single Result 87389 Antibody Rubella 86762 Syphilis Test Non Treponemal Antibody Qualitative Eg Vdrl Rpr Art 86592 Antibody Screen Rbc Each Serum Technique 86850 Blood Typing Abo 86900 And Blood Typing Rh D 86901 |
| 86592-CPT | Low | Syphilis Testing, This Test Detects Antibodies To Syphilis A Bacterial Infection. It Is Frequently Spread By Sexual Contact. Blood Tests Screen For The Infection And Monitor Response To Treatment. |
| 86762-CPT | Low | German Measles Test, The Test Detects Antibodies To The Rubella Virus That Causes German Measles. A Positive Test Indicates Either A Current Infection Or Immunity From A Vaccine. The Test Is Used To Evaluate Immune Status. |
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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