CPT 82365 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 Chemistry Procedures |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 82365 |
| Medicaid Fee Schedule | View Medicaid rates for 82365 |
National average reimbursement for CPT 82365 by major payers:
$11.29
$9.17
$14.78
$18.83
CPT 82365 vs. Other Chemistry Procedures Codes
The CPT 82365 code is part of the Pathology and Laboratory Procedures services used for Chemistry 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 82365 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 |
|---|---|---|
| 82340-CPT | Low | Calcium Lab Test, This Test Measures Calcium Levels Which Helps In Diagnosing Some Conditions Such As Parathryoid And Thyroid Disease. |
| 82360-CPT | Low | Kidney Stone Analysis, This Test Analyzes Kidney Stones For The Presence Of Calcium Carbonate Cystine Magnesium Oxalate Phosphates And Urates. |
| 82365-CPT | Low | Kidney Stone Analysis, This Test Analyzes Kidney Stones For The Presence Of Calcium Carbonate Cystine Magnesium Oxalate Phosphates And Urates. |
| 82378-CPT | Low | Cea (Tumor Marker) Test, This Test Measures The Level Of Cea (Carcinoembryonic Antigen) In The Body. This Is A Protein That May Be Found In Blood Or Other Body Fluids When A Tumor Is Present. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 82365. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 82365 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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