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See a sample rate comparisonCPT 80506 Fee Schedule
Last Verified: September 2026
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.
Doctor Review Of Lab Result, Consulting By A Pathologist To Help A Physician Interpret Test Results. This Can Include Reviewing Drug Levels And May Involve A Review Of A Persons Medical History.
| 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 |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 80506 |
| Medicaid Fee Schedule | View Medicaid rates for 80506 |
National average reimbursement for CPT 80506 by major payers:
$49.42
$38.06
$40.97
$85.56
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CPT 80506
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
St Francis Hospital
$74.32Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$54.93Published rateMatthew Lilley
Bend Memorial Clinic, PC
$45.11Published rateMatthew Lilley
The Orthopedic And Neurosurgical Center Of The Cascades
$27.07Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$18.95Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 80504-CPT | Moderate | Path Clin Consltj Mod 21 40, Pathology Clinical Consultation For A Moderately Complex Clinical Problem With Review Of Patient S History And Medical Records And Moderate Level Of Medical Decision Making When Using Time For Code Selection 21 40 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 |
| 80506-CPT | High | Doctor Review Of Lab Result, Consulting By A Pathologist To Help A Physician Interpret Test Results. This Can Include Reviewing Drug Levels And May Involve A Review Of A Persons Medical History. |
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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