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See a sample rate comparisonCPT 84375 Fee Schedule
Medicare rates as of January 2026
CPT 84375 is classified under Pathology and Laboratory Procedures, in the Chemistry Procedures subgroup.
Test For Metabolic Condition, This Test Is Used To Identify Inherited Metabolic Conditions Involving The Production Or Processing Of Sugars Such As Fructose Galactose And Lactose.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Chemistry Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $39.00 national lab fee schedule rate (2026) · View Medicare rates for 84375 |
| Medicaid Fee Schedule | $35.885 median of the 8 states in the free preview · View Medicaid rates for 84375 |
National average reimbursement for CPT 84375 by major payers:
$29.24
BCBS / Anthem
$19.30
UnitedHealthcare
$33.68
Aetna
$53.64
Cigna
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CPT 84375
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$60.00Published rateSt Davids Healthcare Partnership Lp LLP, North Austin Medical Center
$39.00Published rateEmerus Bhs Sa Thousand Oaks, LLC, Baptist Neighborhood Hospital
Emerus Bhs Sa Thousand Oaks LLC
$39.00Published rateChristopher Raio
Mercy Medical Center
$21.06Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$10.96Published rate
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See a sample payer proposalCPT 84375 vs. Other Chemistry Procedures Codes
The table lists codes related to 84375. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 84375-CPT | Low | Test For Metabolic Condition, This Test Is Used To Identify Inherited Metabolic Conditions Involving The Production Or Processing Of Sugars Such As Fructose Galactose And Lactose. |
| 84376-CPT | Low | Test Sugar Level In Specimen, The Test Is Used To Evaluate If An Infant Is Not Meeting Growth Benchmarks (Failure To Thrive) As A Result Of Inherited Imbalances In Fructose Sucrose Or Lactose. |
| 84378-CPT | Low | Test Sugar Level In Specimen, The Test Is Used To Evaluate If An Infant Is Not Meeting Growth Benchmarks (Failure To Thrive) As A Result Of Inherited Imbalances In Fructose Sucrose Or Lactose. |
| 84379-CPT | Low | Test Sugar Level In Specimen, The Test Is Used To Evaluate If An Infant Is Not Meeting Growth Benchmarks (Failure To Thrive) As A Result Of Inherited Imbalances In Fructose Sucrose Or Lactose. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84375 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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