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See a sample rate comparisonCPT 99080 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.
Special Reports Such As Insura, Special Reports Such As Insurance Forms More Thantheinformation Conveyed In The Usual Medical Comm Unications Or Standard Reporting Form
| 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 | Low |
| Medicare Fee Schedule | View Medicare rates for 99080 |
| Medicaid Fee Schedule | View Medicaid rates for 99080 |
National average reimbursement for CPT 99080 by major payers:
$40.15
$26.91
$16.20
$30.18
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CPT 99080
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateDa Pediatric Rehabilitation
$35.00Published rateRichard Ethridge
$12.75Published rateGlenn Engelman
Southern Monterey County Memorial Hospital
$12.75Published rateSouthern Colorado Ent & Allergy LLC
Southern Colorado Clinic, PC
$10.40Published rate
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See a sample payer proposalCPT 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-CPT | Low | Handling Andor Conveyance Of, Handling Andor Conveyance Of Specimen For Transfer From Thepatient In Other Than A Physicians Office To A Laboratory (Distance May Be Indicated) |
| 99075-CPT | Low | Testimony For A Legal Case, Testimony By A Health Care Professional About Medical Care That Is Provided To A Medical Board In A Deposition Or As A Witness In A Court Case. |
| 99078-CPT | Low | Group Health Education, Physician Or Other Qualified Health Care Professional Qualified By Education Training Licensure Regulation When Applicable Educational Services Rendered To Patients In A Group Setting Eg Prenatal Obesity Or Diabetic Instructions |
| 99080-CPT | Low | Special Reports Such As Insura, Special Reports Such As Insurance Forms More Thantheinformation Conveyed In The Usual Medical Comm Unications 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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