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See a sample rate comparisonCPT 80061 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.
Cholesterol Testing, The Lipid Panel Is A Blood Test That Contains Three Measures: Total Cholesterol Hdl (Good Cholesterol) And Triglycerides. Often Ldl (Bad Cholesterol) Is Calculated From These Results. A Lipid Profile Can Help Evaluate The Risk Of Heart Disease.
| 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 | QW - CLIA Waived Tests 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.39 national lab fee schedule rate (2026) · View Medicare rates for 80061 |
| Medicaid Fee Schedule | $13.225 median of the 8 states in the free preview · View Medicaid rates for 80061 |
National average reimbursement for CPT 80061 by major payers:
$12.72
$9.53
$17.05
$20.30
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CPT 80061
5 of 25 sample ratesHigher to lower in this preview
Shivanck Upadhyay
Aspirus Stanley Hospital & Clinics Inc
$43.84Published rateKelechi Omeonu
North Shore-Lij Medical PC
$13.98Published rateCatherine Yang
Mcr Health Inc
$7.86Published ratePaul Zukoff
New Providence Internal Medicine Associates
$6.09Published rateFaiz Afridi
Allied Digestive Health, LLC
$5.61Published rate
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See a sample payer proposalCPT 80061 vs. Other Organ or Disease Oriented Panels Codes
The CPT 80061 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 80061 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 |
|---|---|---|
| 80061-CPT | Low | Cholesterol Testing, The Lipid Panel Is A Blood Test That Contains Three Measures: Total Cholesterol Hdl (Good Cholesterol) And Triglycerides. Often Ldl (Bad Cholesterol) Is Calculated From These Results. A Lipid Profile Can Help Evaluate The Risk Of Heart Disease. |
| 82465-CPT | Low | Cholesterol Screening, Total Cholesterol Is Measured From A Blood Sample. Cholesterol Testing Is One Measure Of A Persons Risk For Heart Disease. |
| 83718-CPT | Low | Hdl Test (Good Cholesterol), This Test Measures High-Density Lipoprotein (Hdl) Which Transports Cholesterol. It Is The Good Cholesterol Responsible For Decreasing Plaque Deposits Along The Walls Of Blood Vessels. Low Levels Are Linked To Heart Disease. |
| 84478-CPT | Low | Triglycerides, Blood |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80061. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80061 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
CPT 80061 reports a lipid panel, which must include total cholesterol (82465), HDL cholesterol (83718) and triglycerides (84478). LDL is usually calculated from these results.
No. When all three required tests are performed, the panel code 80061 is reported instead of the individual codes. A directly measured LDL (83721) can be reported in addition when ordered.
Medicare pays CPT 80061 under the Clinical Laboratory Fee Schedule, a single national rate based on what private payers paid labs, rather than under the Physician Fee Schedule. Commercial lab rates are negotiated separately and vary widely by payer and by whether the test is run by an independent lab, a hospital outpatient lab or a physician office lab.
This page lists the rates commercial payers have published for CPT 80061 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.