CPT 81020 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 • 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 |
National average reimbursement for CPT 81020 by major payers:
$4.28
$3.83
$4.80
$6.78
| 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 81020 | ||||||
United | 81020 | $2.05 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 81020 | $4.00 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $3.01 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.23 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 81020 | $1.78 | 1164526786 - ASCENSION SETON, ASCENSION SETON MEDICAL CENTER AUSTIN | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $2.16 | 1134126659 - CALDWELL MEMORIAL HOSPITAL INC | 720878037 - (LA) CALDWELL MEMORIAL HOSPITAL, INC. | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.23 | 1104873710 - CLHG-OAKDALE, LLC, OAKDALE COMMUNITY HOSPITAL | 813465783 - (LA) CLHGOAKDALE LLC | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.53 | 1104819366 - CHILDREN'S HOSPITAL | 720467503 - CHILDRENS HOSPITAL INC | LA | Children's Hospital (282NC2000X) |
United | 81020 | $4.23 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.69 | 1598766495 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER,INC | 720423635 - OUR LADY OF LOURDES REGIONAL MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.69 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $7.05 | 1639263189 - LASALLE PARISH HOSPITAL SERVICE DIST NO1, HARDTNER MEDICAL CENTER | 720652984 - (LA) HARDTNER MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 81020 | $4.69 | 1932284411 - FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC, FOUNDATION SURGICAL HOSPITAL OF SAN ANTONIO | 203793927 - (TX) FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.69 | 1679678767 - MATAGORDA COUNTY HOSPITAL DISTRICT, MATAGORDA REGIONAL MEDICAL CENTER | 746025069 - (TX) MATAGORDA COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.23 | 1568663920 - PROGRESSIVE ACUTE CARE AVOYELLES, LLC, AVOYELLES HOSPITAL | 813465468 | LA | General Acute Care Hospital (282N00000X) |
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 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 |
|---|---|---|
| 80434-CPT | Low | Insulin Tolerance Panel; For Acth Insufficiency This Panel Must Include The Following: Cortisol (82533 X 5) Glucose (82947 X 5) |
| 81003-CPT | Low | Urinalysis, By Dip Stick Or Tablet Reagent For Bilirubin, Glucose, Hemoglobin, Ketones, Leukocytes, Nitrite, Ph, Protein, Specific Gravity, Urobilinogen, Any Number Of These Constituents; Automated, Without Microscopy |
| 81005-CPT | Low | Urinalysis; Qualitative Or Semiquantitative, Except Immunoassays |
| 81020-CPT | Low | Urinalysis; Two Or Three Glass Test |
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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