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See a sample rate comparisonCPT 89240 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Pathology Exam Of Body Tissue, A Laboratory Study Of Tissue Organs Or Fluid Samples. A Pathology Study Detects Disease If It Is Present. The Sample May Be Removed During Surgery Or Another Procedure.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Other Pathology and Laboratory Procedures |
| Common Place of Service | 99 - Other POS 50 - Federally Qualified Health Center |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 89240 |
| Medicaid Fee Schedule | View Medicaid rates for 89240 |
National average reimbursement for CPT 89240 by major payers:
$1,123.22
$13.37
$23.94
$73.84
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CPT 89240
5 of 25 sample ratesHigher to lower in this preview
Prisma Health-Midlands, Prisma Health Baptist Parkridge Hospital
Prisma Health-Midlands
$321.17Published rateCrescent City Surgical Centre Operating Company, L.L.C.
Crescent City Surgical Centre
$50.75Published rateVhs San Antonio Partners, LLC, Northeast Baptist Hospital
$49.75Published rateSt Joseph Regional Health Center, St Joseph Ambulatory Surgery
St Joseph Regional Health Center
$45.68Published rateTyler County Hospital District
$2.13Published rate
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See a sample payer proposalCPT 89240 vs. Other Other Pathology and Laboratory Procedures Codes
The CPT 89240 code is part of the Pathology and Laboratory Procedures services used for Other 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 89240 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 |
|---|---|---|
| 89050-CPT | Low | Analysis Of Body Fluid, This Analysis Usually Looks At Body Fluid From The Spine Or A Joint. Numbers Of Each Type Of Cell That Is Present Are Counted Often To Check For An Infection In The Area Near The Sample. |
| 89051-CPT | Low | Analysis Of Body Fluid, This Analysis Usually Looks At Body Fluid From The Spine Or A Joint. Numbers Of Each Type Of Cell That Is Present Are Counted Often To Check For An Infection In The Area Near The Sample. |
| 89055-CPT | Low | Stool White Blood Cell Count, The Test Identifies White Blood Cells (Wbcs) In A Stool Sample. Presence Absence And Quantity Of Wbcs All Give Clues About What Is Causing Diarrhea. |
| 89240-CPT | High | Pathology Exam Of Body Tissue, A Laboratory Study Of Tissue Organs Or Fluid Samples. A Pathology Study Detects Disease If It Is Present. The Sample May Be Removed During Surgery Or Another Procedure. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 89240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 89240 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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