$25.21
80503 represents the straightforward or low-complexity tier for 5–20 minutes. Choose 80505 for high complexity and 41–60 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
80505 Clinical pathology consult Medicare reimbursement rates in Indiana
A pathologist's high-complexity consultation on laboratory findings and clinical context, reported for 41–60 minutes advising the treating clinician. Compare 80505 office and facility rates across CMS payment localities in Indiana.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 80505 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$90.16
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$70.96
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Clinical pathology
About 80505: High-complexity clinical pathology consultation
A pathologist's high-complexity consultation on laboratory findings and clinical context, reported for 41–60 minutes advising the treating clinician.
A clinical pathologist uses this service to assess laboratory findings in the context of a patient's clinical information and advise the treating clinician. The consultation may involve reviewing the medical record and test results, considering the clinical question, and communicating an interpretation or recommendations about laboratory testing. It is a physician consultation service, not the laboratory assay itself.
Select this level when the consultation meets the high-complexity tier and involves 41–60 minutes of work. Documentation should identify the clinical question, relevant records and results reviewed, the pathologist's assessment and recommendations, communication with the treating clinician, and the time supporting this level. CMS assigns work, practice-expense, and malpractice relative value units, with separate practice-expense values for office and facility settings.
Where the value comes from
- Work RVU1.71 · 61%
- Practice expense (office) RVU1.02 · 36%
- Malpractice RVU0.09 · 3%
11.1K
Medicare services in 2024 · #1421 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
80505 compared with similar codes
Office rates for Indiana, from the same CMS release.
$48.86
80504 is the moderate-complexity tier for 21–40 minutes. 80505 represents the higher-complexity tier for 41–60 minutes.
$39.92
80506 identifies prolonged clinical pathology consultation service. 80505 is the high-complexity tier for 41–60 minutes.
Compare 80505 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$90.16
Facility
$70.96
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 80505 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
9,736
- Code
- 80505
- Physician work
- 1.71
- Practice expense
- 1.02
- Malpractice
- 0.09
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.71 | × 1.000 | 1.7100 |
| Practice expense | 1.02 | × 0.927 | 0.9455 |
| Malpractice | 0.09 | × 0.486 | 0.0437 |
| Total RVUs | 2.6993 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$90.16
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1 |
| Practice expense | 1.02 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(1.71 × 1 + 1.02 × 0.927 + 0.09 × 0.486) × $33.4009 = $90.16
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1 |
| Practice expense | 0.4 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(1.71 × 1 + 0.4 × 0.927 + 0.09 × 0.486) × $33.4009 = $70.96
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
80505 billing questions
When should 80505 be selected instead of 80504?
Use 80505 for a high-complexity clinical pathology consultation involving 41–60 minutes. The moderate-complexity tier with 21–40 minutes is represented by 80504.
Does 80505 include the laboratory test?
No. The consultation covers the pathologist's review and advice; it is distinct from the laboratory assay performed on the specimen.
What documentation supports 80505?
Record the clinical question, pertinent clinical information and laboratory findings reviewed, the pathologist's assessment and recommendations, communication with the treating clinician, and the time supporting the selected level.
Can routine review of a test result be reported as 80505?
The service is a clinical pathology consultation addressing a clinical question, not merely routine result processing or review. Document the consultation work and advice provided.
How does 80505 differ from 80506?
80505 represents the high-complexity consultation tier for 41–60 minutes; 80506 is the prolonged-service code in this clinical pathology consultation family.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
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9,73480503,,Path clin consltj sf 5-20,A,,0.43,0.34,,0.10,,0.02,0.79,0.55,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,73580504,,Path clin consltj mod 21-40,A,,0.91,0.57,,0.20,,0.05,1.53,1.16,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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9,73780506,,Path clin consltj prolng svc,A,,0.80,0.40,,0.40,NA,0.05,1.25,1.25,1,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,73881000,,Urinalysis nonauto w/scope,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
9,73981001,,Urinalysis auto w/scope,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915