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See a sample rate comparisonCPT 81020 Fee Schedule
Last Verified: September 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.
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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Urinalysis Procedures |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility 19 - Off Campus Outpatient Hospital |
| Common Modifiers | None QW - CLIA Waived Tests TH |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81020 |
| Medicaid Fee Schedule | View Medicaid rates for 81020 |
National average reimbursement for CPT 81020 by major payers:
$4.28
$3.83
$4.80
$6.79
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CPT 81020
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$10.34Published rateMatagorda County Hospital District, Matagorda Regional Medical Center
Matagorda County Hospital District
$4.69Published rateChildren'S Hospital
Childrens Hospital Inc
$4.53Published rateSt Francis Hospital, Inc., St. Francis Eastside
St Francis Hospital Inc
$4.23Published rateMcallen Hospitals L P, South Texas Health System
$2.81Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 81020 vs. Other Urinalysis Procedures Codes
The CPT 81020 code is part of the Pathology and Laboratory Procedures services used for Urinalysis 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 81020 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 |
|---|---|---|
| 81005-CPT | Low | Urine Analysis For A Substance, Basic Urine Analysis For A Particular Substance Such As Blood Antibodies Bile Or Crystals. The Result May Be Recorded Simply As Positive Or Negative. |
| 81015-CPT | Low | Urine Bacteria Analysis, This Analysis Checks Urine For The Presence Of Bacteria. The Process May Be Manual Or Automated. While Normally There Is No Bacteria In Urine It May Be Present If A Person Is Ill Or If The Sample Is Contaminated. |
| 81020-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. |
| 81025-CPT | Low | Urine Pregnancy Test By Visua, Urine Pregnancy Test By Visual Color Comparison Methodsurine Pregnancy Test By Visual Color Comparison Methods |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81020 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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