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See a sample rate comparisonCPT 84431 Fee Schedule
Last Verified: October 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.
Aspirin Therapy Test, This Test Checks A Urine Sample For A Chemical Byproduct That Makes Blood Platelets Stick Together To Form Clots. The Test Result Will Help Determine Whether Aspirin Will Be An Effective Therapy.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Chemistry Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory GA - Required ABN issued and on file QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.11 national lab fee schedule rate (2026) · View Medicare rates for 84431 |
| Medicaid Fee Schedule | $32.30 median of the 8 states in the free preview · View Medicaid rates for 84431 |
National average reimbursement for CPT 84431 by major payers:
$25.75
$17.43
$31.77
$76.12
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CPT 84431
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$77.24Published rateChristopher Raio
Mercy Medical Center
$41.71Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$23.03Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$17.00Published rateNevada Eye Care Professionals Little & Stein, Ltd.
Nevada Eye Care Professionals
$7.79Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 84431 vs. Other Chemistry Procedures Codes
The CPT 84431 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 84431 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 |
|---|---|---|
| 84307-CPT | Low | Somatostatin Plasma Test, This Test Measures Somatostatin A Hormone Found In The Brain And Secreted By Digestive Organs. Its Purpose Is To Slow Stop Or Limit The Action Of Growth Hormone The Digestive Process And Production Of Insulin And Glucose. |
| 84410-CPT | Low | Testosterone; Bioavailable Direct Measurement (Eg Differential Precipitation). (Reinstated 01/01/2017). Thallium Blood Or Urine (Del 03/31/2003) |
| 84431-CPT | Low | Aspirin Therapy Test, This Test Checks A Urine Sample For A Chemical Byproduct That Makes Blood Platelets Stick Together To Form Clots. The Test Result Will Help Determine Whether Aspirin Will Be An Effective Therapy. |
| 84432-CPT | Low | Test Thyroid Immune Function, The Test Evaluates The Immune Function Of The Thyroid Gland By Checking For Thyroglobulin An Antibody That Causes The Thyroid Gland To Self-Destruct. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 84431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 84431 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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