CPT 89240 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Other Pathology and Laboratory Procedures Pathology and Laboratory Procedures |
| Common Place of Service | 99 - Other POS 50 - Federally Qualified Health Center |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 89240 |
National average reimbursement for CPT 89240 by major payers:
$1,123.22
$13.37
$23.94
$73.84
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 89240 | $10.03 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 89240 | $81.26 | 1316505043 - ETHICUS HOSPITAL DFW LLC, LEGENT ORTHOPEDIC HOSPITAL | 263044485 - (TX) ETHICUS HOSPITAL DFW | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1063466035 - CHCA CLEAR LAKE LP, HCA HOUSTON HEALTHCARE CLEAR LAKE | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $6.03 | 1306843826 - WEST CARROLL HEALTH SYSTEMS LLC, WEST CARROLL MEMORIAL HOSPITAL | 562300247 - WEST CARROLL HEALTH SYSTEMS L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $39.70 | 1588654966 - ST. JAMES PARISH HOSP. SERV. DIST. | 726010747 - (LA) ST JAMES PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 89240 | $3.70 | 1881665164 - CLHG-LEESVILLE, BYRD REGIONAL HOSPITAL | 824337635 | LA | General Acute Care Hospital (282N00000X) |
United | 89240 | $50.75 | 1295036770 - CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY, L.L.C. | 270508997 - (LA) CRESCENT CITY SURGICAL CENTRE | LA | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1831975572 - DECATUR HEALTH SERVICES, LLC | 932081386 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1205189172 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $225.30 | 1609807122 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1750819025 - NORTH HOUSTON, HCA HOUSTON HEALTHCARE TOMBALL | 821349955 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $2.13 | 1447259627 - TYLER COUNTY HOSPITAL DISTRICT | 746067306 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $49.75 | 1467129700 - VHS SAN ANTONIO PARTNERS, LLC, NORTHEAST BAPTIST HOSPITAL | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 89240 | $50.75 | 1295036770 - CRESCENT CITY SURGICAL CENTRE OPERATING COMPANY, L.L.C. | 270508997 - (LA) CRESCENT CITY SURGICAL CENTRE | LA | General Acute Care Hospital (282N00000X) |
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 89240 vs. Other Pathology and Laboratory Procedures Codes
The CPT 89240 code is part of the Other Pathology and Laboratory 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 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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