CPT 84206 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 | Chemistry Procedures Pathology and Laboratory Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84206 |
National average reimbursement for CPT 84206 by major payers:
$20.99
$15.64
$26.75
$38.96
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 84206 | $24.41 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84206 | $24.02 | 1417505694 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH HILLCREST HOSPITAL VASCULAR LAB | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84206 | $9.34 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 84206 | $16.01 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84206 | $26.69 | 1457994188 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MICRO-HOSPITAL WESLACO | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 84206 | $16.01 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 84206 | $15.31 | 1679551311 - CATHERINE LEE | 311425166 - COLUMBUS ARTHRITIS CENTER | OH | Rheumatology Physician (207RR0500X) |
United | 84206 | $60.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 84206 | $10.45 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 84206 | $35.23 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84206 | $24.02 | 1821544925 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SENECA | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84206 | $58.72 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 84206 | $9.34 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 84206 | $14.41 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84206 | $24.02 | 1568532513 - GREENVILLE HEALTH SYSTEM, GHS PATEWOOD MEMORIAL HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | 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 84206 vs. Other Pathology and Laboratory Procedures Codes
The CPT 84206 code is part of the Chemistry 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 84206 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 |
|---|---|---|
| 84206-CPT | Low | Digestive Enzyme Test, The Test Measures Proinsulin Made By The Pancreas To Help Digest Sugars. It Is Involved In The Conversion Of Glucose. |
| 84233-CPT | Low | Breast Cancer Therapy Test, The Test Checks How A Sample Of Tissue (Biopsy) Responds To Chemotherapy Or Hormone Therapy That Has Been Proposed To Treat Breast Cancer. |
| 84305-CPT | Low | Liver Protein Test, This Liver Protein Test Measures Somatomedin Which Has An Important Relationship With Growth Hormone. |
| 84402-CPT | Low | Testosterone Hormone Test, Testosterone Helps Balance Male-Female Secondary Sex Characteristics Like Body Hair. Results Help Evaluate Pituitary Gland And Sex Gland Conditions. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84206. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84206 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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