CPT 80506 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 | • Pathology and Laboratory Procedures • Clinical Pathology Consultations |
| Common Place of Service | • 11 - Office • 81 - Independent Laboratory |
| Common Modifiers | • None • QW - CLIA Waived Tests • 26 - Professional Component Only (separate from technical component) |
| Complexity Level | High |
National average reimbursement for CPT 80506 by major payers:
$49.42
$38.06
$40.97
$88.05
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 80506 | ||||||
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CPT 80506 vs. Other Clinical Pathology Consultations Codes
The CPT 80506 code is part of the Pathology and Laboratory Procedures services used for Clinical Pathology Consultations. 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 80506 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 |
|---|---|---|
| 80417 | Low | Peripheral Vein Renin Stimulation Panel |
| 80428 | Low | Growth Hormone Stimulation Panel (Eg, Arginine Infusion, L-Dopa Administration) This Panel Must Include The Following: Human Growth Hormone (Hgh) (83003 X 4) |
| 80503 | Low | 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. |
| 80506 | High | 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80506. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80506 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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