CPT 84238 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 | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory Q4 - Service for ordering / referring physician qualifies as a service exemption for laboratory services |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84238 |
| Medicaid Fee Schedule | View Medicaid rates for 84238 |
National average reimbursement for CPT 84238 by major payers:
$31.48
$26.68
$40.39
$53.30
CPT 84238 vs. Other Chemistry Procedures Codes
The CPT 84238 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 84238 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. |
| 84238-CPT | Low | Receptor Assay;Non-Endocrine-Eg,Acetylch |
| 84425-CPT | Low | Vitamin B1 Deficiency Test, This Test Can Measure A Deficiency Of Vitamin B1 (Thiamine). Thiamine Helps Convert Carbohydrates To Energy And Is Good For The Heart Muscles And Nerves. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84238 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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