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See a sample rate comparisonCPT 80434 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.
Acth Insufficiency Test, This Test Uses A Pretest Blood Sample As A Baseline To Compare A Fasting Blood Sample After Taking Insulin. The Test Measures Acth To Evaluate Interaction Between The Hypothalamus And Pituitary Gland In The Brain And The Adrenal Glands.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Evocative/Suppression Testing Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | $285.03 national lab fee schedule rate (2026) · View Medicare rates for 80434 |
| Medicaid Fee Schedule | $262.225 median of the 8 states in the free preview · View Medicaid rates for 80434 |
National average reimbursement for CPT 80434 by major payers:
$195.68
$133.46
$240.29
$395.14
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CPT 80434
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$627.07Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$256.52Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$256.52Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$102.33Published rateAll Ways Homecare Inc
$40.00Published rate
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See a sample payer proposalCPT 80434 vs. Other Evocative/Suppression Testing Procedures Codes
The CPT 80434 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 80434 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 |
|---|---|---|
| 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. |
| 80434-CPT | Low | Acth Insufficiency Test, This Test Uses A Pretest Blood Sample As A Baseline To Compare A Fasting Blood Sample After Taking Insulin. The Test Measures Acth To Evaluate Interaction Between The Hypothalamus And Pituitary Gland In The Brain And The Adrenal Glands. |
| 81000-CPT | Low | Urine Analysis, Urine Test That Checks Ph And Looks For Substances Such As Blood Crystals Bile And White Blood Cells (Antibodies). These May Be Viewed Under A Microscope Or Detected With Dip Sticks Or Colorizing Tablets. A Computer Analysis May Be Done As Well. |
| 81050-CPT | Low | Urine Flow Study, Several Urine Collections Are Made Over A Given Period Such As 24 Hours. Both The Volume And Speed Are Measured Usually As Amount Per Second. The Results May Be Used As A Baseline For Other Tests Or Simply To Check A Persons Ability To Urinate. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80434. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80434 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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