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See a sample rate comparisonCPT 84235 Fee Schedule
Last Verified: September 2026
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.
Hormone Receptor Test, This Test Evaluates How Well A Particular Hormone Sends And Receives Information So That Processes Within The Body Perform Optimally.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Chemistry Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84235 |
| Medicaid Fee Schedule | View Medicaid rates for 84235 |
National average reimbursement for CPT 84235 by major payers:
$55.78
$42.74
$69.27
$99.68
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CPT 84235
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$156.71Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$71.23Published rateGreenville Health System, Ghs Patewood Memorial Hospital
Prisma Health - Upstate
$64.11Published rateChristopher Raio
St Francis Hospital
$38.46Published rateMethodist Hospital Plainview Texas, Covenant Hospital Plainview
Methodist Hospital Plainview Texas
$29.92Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 84235 vs. Other Chemistry Procedures Codes
The CPT 84235 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 84235 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 |
|---|---|---|
| 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. |
| 84234-CPT | Low | Cancer Treatment Assessment, Testing The Receptive Ability Of The Hormone Progesterone Is Used To Assess The Likelihood Of Cancer Treatment Effectiveness. Treatment For Several Types Of Cancer May Be Evaluated With This Test. |
| 84235-CPT | Low | Hormone Receptor Test, This Test Evaluates How Well A Particular Hormone Sends And Receives Information So That Processes Within The Body Perform Optimally. |
| 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 84235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84235 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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