CPT 84311 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 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 84311 |
National average reimbursement for CPT 84311 by major payers:
$6.79
$5.34
$8.54
$12.07
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 84311 | $4.86 | 1497944565 - MICHAEL SHULER | 581076549 - ATHENS ORTHOPEDIC CLINIC, P.A. | GA | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 84311 | $4.37 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84311 | $7.28 | 1568532513 - GREENVILLE HEALTH SYSTEM, GHS PATEWOOD MEMORIAL HOSPITAL | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84311 | $4.37 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84311 | $4.86 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 84311 | $4.86 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 84311 | $7.28 | 1255367637 - OCONEE MEDICAL CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84311 | $9.62 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 84311 | $12.15 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 84311 | $7.28 | 1417505694 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH HILLCREST HOSPITAL VASCULAR LAB | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 84311 | $8.10 | 1982800397 - PELHAM MEDICAL CENTER | 141996067 | SC | General Acute Care Hospital (282N00000X) |
United | 84311 | $8.10 | 1972503910 - WACCAMAW COMMUNITY HOSPITAL, TIDELANDS WACCAMAW COMMUNITY HOSPITAL | 43633263 - WACCAMAW COMMUNITY HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 84311 | $10.69 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 84311 | $5.50 | 1033320049 - ANN STECK | 344428256 - TOLEDO HOSPITAL | OH | Family Medicine Physician (207Q00000X) |
United | 84311 | $8.10 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
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 84311 vs. Other Pathology and Laboratory Procedures Codes
The CPT 84311 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 84311 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 |
|---|---|---|
| 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. |
| 84300-CPT | Low | Sodium Electrolyte Test, Sodium Is An Electrolyte Helping The Body Stay Hydrated. The Blood Test Determines Fluid Retention Or Dehydration. The Urine Test Detects Too Much Or Too Little Sodium. The Tests Help Monitor High Blood Pressure And Kidney Function. |
| 84302-CPT | Low | Sodium Electrolyte Test, Sodium Is An Electrolyte Helping The Body Stay Hydrated. The Blood Test Determines Fluid Retention Or Dehydration. The Urine Test Detects Too Much Or Too Little Sodium. The Tests Help Monitor High Blood Pressure And Kidney Function. |
| 84311-CPT | Low | Lab Analysis With Light Waves, Spectrophotometry Is A Testing Method That Examines Visible Ultraviolet And Infrared Light Waves Shone Onto A Body Fluid Sample. The Method Measures The Amount Of Light Absorbed By The Sample. Results Indicate Density Of A Material In The Fluid. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84311. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84311 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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