CPT 80418 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 Evocative/Suppression Testing Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | None |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 80418 |
| Medicaid Fee Schedule | View Medicaid rates for 80418 |
National average reimbursement for CPT 80418 by major payers:
$454.45
$407.94
$617.65
$840.78
CPT 80418 vs. Other Evocative/Suppression Testing Procedures Codes
The CPT 80418 code is part of the Pathology and Laboratory Procedures services used for Evocative/Suppression Testing 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 80418 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 |
|---|---|---|
| 80418-CPT | Moderate | Pituitary Evaluation Panel, Combined Rapid Anterior Pituitary Evaluation Panel This Panel Must Include The Following: Adrenocorticotropic Hormone (Acth) (82024 X 4) Luteinizing Hormone (Lh) (83002 X 4) Follicle Stimulating Hormone (Fsh) (83001 X 4) Prolactin (84146 X 4) Human Growth Hormone (Hgh) (83003 X 4) Cortisol (82533 X 4) Thyroid Stimulating Hormone (Tsh) (84443 X 4) |
| 80420-CPT | Low | Test For Cushings Syndrome, The Dexamethasone Suppression Test Is An Evaluation For Cushings Syndrome In Which The Adrenal Glands Make Too Much Cortisol. Two Blood Samples Are Taken To Compare: One Before A Dose Of Dexamethasone And Another The Next Morning. |
| 80422-CPT | Low | Glucagon Test Series, The Glucagon Tolerance Test Helps Diagnose Hypoglycemic And Insulin Conditions. A Two-Minute Glucagon Iv Injection Causes An Insulin Peak. Glucose And Insulin Levels Are Measured At Baseline And Timed Intervals. |
| 80426-CPT | Low | Fertility Hormone Test, The Human Chorionic Gonadotropin (Hcg) Stimulation Test Helps To Determine Whether Reproductive Hormones Are Functioning Properly. Testosterone Estradiol Follicle Stimulating Hormone (Fsh) Or Luteinizing Hormone (Lh) Are Measured After An Injection Of Hcg. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80418. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80418 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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