CPT 80435 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 81 - Independent Laboratory |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80435 |
| Medicaid Fee Schedule | View Medicaid rates for 80435 |
National average reimbursement for CPT 80435 by major payers:
$87.89
$72.79
$111.95
$148.75
CPT 80435 vs. Other Evocative/Suppression Testing Procedures Codes
The CPT 80435 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 80435 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. |
| 80432-CPT | Low | Pancreatic Function Test, This Test Evaluates The Possibility Of Insulin Suppressing The Secretion Of C-Peptides By The Pancreas. In A Healthy Organ The Substances Are Secreted Equally And Work Together. |
| 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. |
| 80435-CPT | Low | Insulin Growth Factor Test, Insulin-Like Growth Factor (Igf-1) Is Often Tested Along With One Of The Growth Hormone (Hgh) Tests. Hgh Levels Change During The Day But Igf-1 Stays Steady. The Test Can Be Used To Monitor Average Hgh Levels And It May Reveal Damage To The Pituitary Gland. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80435. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80435 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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