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See a sample rate comparisonCPT 84163 Fee Schedule
Medicare rates as of January 2026
CPT 84163 is classified under Pathology and Laboratory Procedures, in the Chemistry Procedures subgroup.
Pregnancy Plasma Protein Test, Pregnancy Associated Plasma Protein-A (Papp-A) Is A Blood Test That Can Help Identify Whether A Fetus Is At Risk For Down Syndrome. It Can Also Alert A Physician To Potential Heart Problems.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Chemistry Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.05 national lab fee schedule rate (2026) · View Medicare rates for 84163 |
| Medicaid Fee Schedule | $14.86 median of the 8 states in the free preview · View Medicaid rates for 84163 |
National average reimbursement for CPT 84163 by major payers:
$12.66
BCBS / Anthem
$13.22
UnitedHealthcare
$16.15
Aetna
$46.47
Cigna
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CPT 84163
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$33.11Published rateCatherine Lee
Columbus Arthritis Center
$21.56Published rateChristopher Raio
Mercy Medical Center
$15.05Published rateMolly Mcintosh
Baycare Medical Group Inc
$12.39Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$6.76Published rate
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See a sample payer proposalCPT 84163 vs. Other Chemistry Procedures Codes
The table lists codes related to 84163. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 83970-CPT | Low | Parathyroid Hormone Test, Pth (Parathyroid Hormone) Helps The Body Absorb And Use Calcium And Phosphorus. Both Minerals Affect Bone Health. This Blood Test Identifies High Levels Of Pth Which Indicates The Body Is Losing Calcium And Phosphorus. |
| 83987-CPT | Low | Screening Test For Asthma, Test To Evaluate The Severity Of Asthma By Measuring The Ph Level Of Condensation From Breathing Out. |
| 84140-CPT | Low | Pregnenolone Hormone Test, Pregnenolone Is A Steroid Needed By Other Hormones For Transformation. It Also Plays A Role In Healthy Nerve Structure. Pregnenolone Is Produced In The Adrenal Glands Where It Interacts With Reproductive Hormones. |
| 84163-CPT | Low | Pregnancy Plasma Protein Test, Pregnancy Associated Plasma Protein-A (Papp-A) Is A Blood Test That Can Help Identify Whether A Fetus Is At Risk For Down Syndrome. It Can Also Alert A Physician To Potential Heart Problems. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84163. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84163 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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