CPT 80081 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 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80081 |
| Medicaid Fee Schedule | View Medicaid rates for 80081 |
National average reimbursement for CPT 80081 by major payers:
$65.04
$52.61
$79.28
$126.08
CPT 80081 vs. Other Organ or Disease Oriented Panels Codes
The CPT 80081 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 80081 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 |
| 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. |
| 87340-CPT | Low | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Hepatitis B Surface Antigen (Hbsag) (Desc Rvsd 10/6/20) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80081. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80081 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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