CPT 80505 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Clinical Pathology Consultations Pathology and Laboratory Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None QW - CLIA Waived Tests 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 80505 |
National average reimbursement for CPT 80505 by major payers:
$106.84
$84.59
$101.08
$153.79
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 80505 | $241.56 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 80505 | $782.16 | 1841746948 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-GREER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 80505 | $63.43 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 80505 | $157.25 | 1982800397 - PELHAM MEDICAL CENTER | 141996067 | SC | General Acute Care Hospital (282N00000X) |
United | 80505 | $782.16 | 1942756051 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH INT MED/SUBSPEC CLINIC | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 80505 | $104.51 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 80505 | $59.93 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 80505 | $116.12 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 80505 | $60.15 | 1891774519 - LEON HOME HEALTH, LLC, LEON AT HOME | 261288029 | FL | Home Health Agency (251E00000X) |
United | 80505 | $167.21 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 80505 | $782.16 | 1437605532 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PEDIATRIC MED | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 80505 | $160.73 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 80505 | $137.08 | 1588648315 - POINTE COUPEE PARISH HEALTH SERVICES DISTRICT NUMBER ONE, POINTE COUPEE GENERAL HOSPITAL | 721054801 | LA | Critical Access Hospital (282NC0060X) |
United | 80505 | $167.21 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 80505 | $241.56 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 80505 vs. Other Pathology and Laboratory Procedures Codes
The CPT 80505 code is part of the Clinical Pathology Consultations services used for Pathology and Laboratory 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 80505 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 |
|---|---|---|
| 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. |
| 80503-CPT | Low | Path Clin Consltj Sf 5 20, Pathology Clinical Consultation For A Clinical Problem With Limited Review Of Patient S History And Medical Records And Straightforward Medical Decision Making When Using Time For Code Selection 5 20 Minutes Of Total Time Is Spent On The Date Of The Consultation |
| 80505-CPT | High | Path Clin Consltj High 41 60, Pathology Clinical Consultation For A Highly Complex Clinical Problem With Comprehensive Review Of Patient S History And Medical Records And High Level Of Medical Decision Making When Using Time For Code Selection 41 60 Minutes Of Total Time Is Spent On The Date Of The Consultation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80505 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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