CPT 83540 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 11 - Office |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 83540 |
| Medicaid Fee Schedule | View Medicaid rates for 83540 |
National average reimbursement for CPT 83540 by major payers:
$5.47
$4.58
$8.14
$9.41
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 83540 | $6.46 | 1023117306 - GURINDER LUTHRA | 760010407 | TX | Gastroenterology Physician (207RG0100X) |
United | 83540 | $5.78 | 1609851690 - ROBERT ANTONELLE | 815309615 | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $3.96 | 1275856106 - UZMA ABBASI | 261147857 - (NY) ONEIDA MEDICAL PRACTICE P C | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $3.82 | 1003163486 - MATTHEW SETO | 841001906 - (CO) BOULDER VALLEY GASTROENTEROLOGY, INC. | CO | Gastroenterology Physician (207RG0100X) |
United | 83540 | $3.66 | 1609571546 - SHAILAJA JAMMA MD PA | 921604153 - (TX) SHAILAJA JAMMA MD PA | TX | Gastroenterology Physician (207RG0100X) |
United | 83540 | $2.91 | 1518965250 - JANE VLODOV-LEVITT | 113592811 - JANE VLODOV-LEVITT, M.D., P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $6.15 | 1578540266 - ALFRED ROSTON | 815309615 | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $3.88 | 1922486125 - QIN RAO | 452573467 - (NY) MANHATTAN GASTROENTEROLOGY P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $35.50 | 1508253303 - MICHAEL LI | 943281657 | CA | Gastroenterology Physician (207RG0100X) |
United | 83540 | $12.34 | 1033301502 - HOMAYON SIDIQ | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Gastroenterology Physician (207RG0100X) |
United | 83540 | $7.48 | 1720013139 - BETH SCHORR-LESNICK | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $3.90 | 1750402046 - MICHAEL PIESMAN | 741967809 - (TX) GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A. | TX | Gastroenterology Physician (207RG0100X) |
United | 83540 | $9.06 | 1902960560 - JOSEPH CHOMA | 222563241 - SOUTHWESTERN VERMONT MEDICAL CENTER INC | NY | Gastroenterology Physician (207RG0100X) |
United | 83540 | $5.46 | 1790771715 - RICHARD TAY | 481058737 - (KS) PRATT REGIONAL MEDICAL CENTER CORPORATION | TX | Gastroenterology Physician (207RG0100X) |
United | 83540 | $22.55 | 1912327529 - NEERAJ MANGLA | 237064656 - HEALING THE SOUL | CA | Gastroenterology Physician (207RG0100X) |
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 83540 vs. Other Chemistry Procedures Codes
The CPT 83540 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 83540 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 |
|---|---|---|
| 83003-CPT | Low | Human Growth Hormone Test, Human Growth Hormone (Hgh) Affects Numerous Development Functions. Both Blood And Amniotic Fluid May Be Tested. The Results Can Show Problems Either With The Pituitary Gland Or With Adrenal Gland Hormone Regulation. |
| 83013-CPT | Low | Digestive Bacteria Breath Test, Test That Analyzes Exhaled Breath After Taking A Urea Pill To Determine If Helicobacter Pylori (H. Pylori) Bacteria Is Present In The Digestive System. This Bacteria Can Cause Stomach Ache And Ulcers. |
| 83014-CPT | Low | Drug For Bacteria Test, The Test For Helicobacter Pylori (Bacteria Associated With Ulcers) Requires Taking A Drug With A Small Amount Of Radioactive Material Followed By A Breath Test. If The Bacteria Are Present The Pill Changes The Character Of The Breath. |
| 83540-CPT | Low | Blood Test For Iron, This Test Measures The Amount Of Iron In A Blood Sample. It Is Used To Identify Iron Deficiency Or Iron Poisoning. The Test Often Is Conducted Along With Others To Evaluate Illness Or Disease. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 83540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 83540 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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