CPT 84228 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 |
| Common Modifiers | None GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84228 |
National average reimbursement for CPT 84228 by major payers:
$10.48
$8.26
$12.76
$17.74
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 84228 | $10.47 | 1629432869 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OP SURGERY SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84228 | $15.35 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84228 | $10.47 | 1720747496 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH TRANSPLANT CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84228 | $11.63 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 84228 | $25.59 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 84228 | $17.45 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 84228 | $11.63 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 84228 | $5.42 | 1770573586 - MCALLEN HOSPITALS L P, SOUTH TEXAS HEALTH SYSTEM | 233069260 | TX | General Acute Care Hospital (282N00000X) |
United | 84228 | $22.18 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 84228 | $11.63 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 84228 | $4.19 | 1568801116 - VICTORY MEDICAL CENTER LANDMARK, LP | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 84228 | $8.50 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | 84228 | $11.63 | 1982800397 - PELHAM MEDICAL CENTER | 141996067 | SC | General Acute Care Hospital (282N00000X) |
United | 84228 | $10.47 | 1437605532 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PEDIATRIC MED | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84228 | $6.98 | 1497944565 - MICHAEL SHULER | 581076549 - ATHENS ORTHOPEDIC CLINIC, PA | GA | Orthopaedic Hand Surgery Physician (207XS0106X) |
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 84228 vs. Other Pathology and Laboratory Procedures Codes
The CPT 84228 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 84228 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 |
|---|---|---|
| 84207-CPT | Low | Pyridoxine (Vitamin B 6) |
| 84228-CPT | Low | Malaria Medication Monitoring, Quinine Is An Antimalarial Drug That Can Cause Severe Side Effects. Its Use Is Monitored To Ensure The Lowest Possible Therapeutic Dose As Well As To Check For Toxicity. |
| 84270-CPT | Low | Hormone Binding Protein Test, The Test Checks Sex Hormone Binding Globulin (Shbg) Levels Which Shows How Much Testosterone Is Available To The Body. This Helps Diagnose Fertility And Thyroid Gland Problems And Can Help In Monitoring Hormone Therapy. |
| 84275-CPT | Low | Sialic Acid Enzyme Test, This Test Measures The Amount Of Sialic Acid In The Body. Sialic Acid Is Part Of The Digestion Process That Breaks Down Sugar-Protein Complexes. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84228. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84228 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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