CPT 99080 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 | • Medicine Services and Procedures • Special Services, Procedures and Reports |
| Common Place of Service | • 11 - Office • 20 - Urgent Care Facility • None |
| Common Modifiers | • None • 73 - Discontinued Outpatient Services • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99080 by major payers:
$40.15
$26.91
$16.20
$30.21
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99080 | ||||||
United | 99080 | $50.00 | 1508126426 - CAITLYN LESH | 161533232 - KALEIDA HEALTH | CO | Surgery Physician (208600000X) |
United | 99080 | $40.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 99080 | $12.75 | 1164515847 - SEVERN BARLOCO | 208854074 | CO | Surgery Physician (208600000X) |
United | 99080 | $60.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 99080 | $60.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 99080 | $55.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 99080 | $55.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 99080 | $35.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 99080 | $12.75 | 1215297221 - STEPHANIE HERNANDEZ | 383989996 | TX | Psychiatry Physician (2084P0800X) |
United | 99080 | $12.75 | 1922442912 - HANNAH FLORY | 752566987 | CO | Surgery Physician (208600000X) |
United | 99080 | $12.75 | 1215297221 - STEPHANIE HERNANDEZ | 383989996 | IL | Psychiatry Physician (2084P0800X) |
United | 99080 | $60.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 99080 | $12.75 | 1003812942 - JOSEPH COCCO | 1003812942 - (CO) JOSEPH COCCO | CO | Surgery Physician (208600000X) |
United | 99080 | $12.75 | 1457472425 - AMANDA PARKER | 205114071 | CO | Surgery Physician (208600000X) |
United | 99080 | $10.40 | 1851412134 - SOUTHERN COLORADO ENT & ALLERGY LLC | 841074070 - (CO) SOUTHERN COLORADO CLINIC, PC | CO | Specialist (174400000X) |
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 99080 vs. Other Special Services, Procedures and Reports Codes
The CPT 99080 code is part of the Medicine Services and Procedures services used for Special Services, Procedures and Reports. 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 99080 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 |
|---|---|---|
| 99001 | Low | Handling And/Or Conveyance Of Specimen For Transfer From The Patient In Other Than An Office To A Laboratory (Distance May Be Indicated) (Revised 01/01/13) |
| 99002 | Low | Handling Conveyance And/Or Any Other Service In Connection With The Implementation Of An Order Involving Devices (Eg Designing Fitting Packaging Handling Delivery Or Mailing) When Devices Such As Orthotics Protectives Prostheticare Fabricated By An Outside Laboratory Or Shop But Which Items Have Been Designed And Are To Be Fitted And Adjusted By The Attending Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
| 99075 | Low | Medical Testimony |
| 99080 | Low | Special Reports Such As Insurance Forms, More Than The Information Conveyed In The Usual Medical Communications Or Standard Reporting Form |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99080. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99080 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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