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 | Urinalysis Procedures Pathology and Laboratory 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 |
National average reimbursement for CPT 81020 by major payers:
$4.28
$3.83
$4.80
$6.79
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81020 | $4.23 | 1568663920 - PROGRESSIVE ACUTE CARE AVOYELLES, LLC, AVOYELLES HOSPITAL | 813465468 | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.69 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.69 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 81020 | $10.34 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81020 | $4.23 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81020 | $4.69 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 81020 | $4.70 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
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 | $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 | 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 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81020 | $4.53 | 1104819366 - CHILDREN'S HOSPITAL | 720467503 - CHILDRENS HOSPITAL INC | LA | Children's Hospital (282NC2000X) |
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 | $4.69 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 81020 | $3.08 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | 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 Pathology and Laboratory Procedures Codes
The CPT 81020 code is part of the Urinalysis Procedures 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 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 | Acth Insufficiency Test, This Test Uses A Pretest Blood Sample As A Baseline To Compare A Fasting Blood Sample After Taking Insulin. The Test Measures Acth To Evaluate Interaction Between The Hypothalamus And Pituitary Gland In The Brain And The Adrenal Glands. |
| 81003-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. |
| 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. |
| 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. |
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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