CPT code 80504: Pathology consult2026 Medicare rate & RVUs in Maine
Reports a pathologist’s moderate-complexity consultation on a clinical laboratory question, associated with 21–40 minutes of service.
Medicare pays $48.95–$50.32 for 80504 in the office in Maine, from Rest Of Maine to Southern Maine. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 80504 covers
A pathologist provides clinical analysis in response to a treating clinician’s question about laboratory testing or results. Typical work may include reviewing the patient’s relevant records and laboratory data, evaluating an unexpected or conflicting result, advising on test selection, and communicating an interpretation or recommendation. Examples include consultation about a difficult-to-interpret coagulation result or a microbiology finding that needs clinical context. The service may occur in a hospital or outpatient setting and is distinct from simply processing a specimen or reporting a routine test result.
Use 80504 for the moderate-complexity tier, associated with 21–40 minutes. The consultation record should identify the clinical question, relevant information reviewed, analysis and recommendations, and time spent when time supports code selection. Medicare assigns work, practice-expense, and malpractice RVUs through the physician fee schedule, with separate office and facility practice-expense values.
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.
Where 80504 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | $48.95 | $37.58 |
| Southern Maine | $50.32 | $38.07 |
How the 80504 rate is calculated
Each of 80504’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 80504
RVUs × geographic indexes × conversion factor
Work0.91
0.91 RVUs× 1.000 GPCI
Practice expense0.57
0.57 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.5300
Conversion factor
$33.4009
Medicare rate
$51.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 80504
80504 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 80504
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$51.10
- Non-facility (office)
- $51.10
- Facility
- $38.75
Higher because the practice carries its own overhead.
80504 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 80503Pathology consultation
- Choose 80503 for the lower-complexity consultation tier, rather than the moderate tier associated with 80504.
- 80505Clinical pathology consult
- Choose 80505 when the consultation meets the high-complexity tier and its associated 41–60-minute band; 80504 is the moderate tier.
- 80506Pathology consultation
- 80506 addresses prolonged consultation service, rather than the moderate-complexity base consultation represented by 80504.
80504 billing questions
How does 80504 differ from 80503 or 80505?
80504 is the moderate-complexity tier associated with 21–40 minutes. 80503 is the lower tier, while 80505 is the high-complexity tier associated with 41–60 minutes.
Can a routine lab result review support 80504?
Routine review or reporting of a test result alone is not the clinical consultation described here. The record should show a clinical question and the pathologist’s consultative analysis.
Is 80504 reported per test or specimen?
The code describes the consultation service, not a unit for each test or specimen reviewed. Document the question and consultative work rather than counting individual results.
What documentation supports 80504?
Document the requesting clinician’s question, pertinent clinical and laboratory information reviewed, the pathologist’s reasoning, and the interpretation or recommendations. Include time when it supports selection of this tier.
Is a discussion with the treating clinician part of the consultation?
Communication about the clinical interpretation or recommendations can be part of the consultative work. The note should make clear what was reviewed and what guidance was provided.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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