CPT 84030 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 | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None 26 - Professional component QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84030 |
| Medicaid Fee Schedule | View Medicaid rates for 84030 |
National average reimbursement for CPT 84030 by major payers:
$4.85
$8.98
$6.32
$8.38
CPT 84030 vs. Other Chemistry Procedures Codes
The CPT 84030 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 84030 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 |
|---|---|---|
| 84030-CPT | Low | Newborn Pku Screen, The Pku Screen Identifies An Inherited Condition That Damages The Central Nervous System And Brain. All Newborns Are Screened For A Critical Enzyme Used To Digest Amino Acids From Foods Containing Proteins. |
| 84035-CPT | Low | Newborn Pku Screen, The Pku Screen Identifies An Inherited Condition That Damages The Central Nervous System And Brain. All Newborns Are Screened For A Critical Enzyme Used To Digest Amino Acids From Foods Containing Proteins. |
| 84105-CPT | Low | Phosphorus Trace Element Test, The Urine Phosphorus Test Checks For Calcium Absorption And Kidney Function. Phosphorus Is A Trace Element Required For Proper Digestion Bone Formation And Kidney Health. It Aids The Balance Of Calcium Potassium And Glucose. |
| 84132-CPT | Low | Potassium Electrolyte Test, Potassium Is An Electrolyte Critical For Heart And Skeletal Muscles. The Blood Test Measures Overall Potassium. The Urine Test Verifies High Levels Related To Kidney Disease. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84030. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84030 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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