$26.96
80503 represents a limited consultation. 80506 is an add-on for prolonged time and must accompany its primary service.
On this page
CMS RVU26D · Effective 2026-10-01
80506 Pathology consultation Medicare reimbursement rates in Rhode Island
Report 80506 for additional time spent by a clinical pathologist on a prolonged consultation after the initial high-level consultation service. Compare 80506 office and facility rates across CMS payment localities in Rhode Island.
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 80506 in Rhode Island?
Rhode Island 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
$42.52
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
No supported rate
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 80506: Prolonged clinical pathology consultation
Report 80506 for additional time spent by a clinical pathologist on a prolonged consultation after the initial high-level consultation service.
A clinical pathologist uses this add-on for extended consultation with a treating clinician about laboratory findings, test selection, or interpretation. The work may involve reviewing current and prior results, relevant diagnostic studies, and clinical information, then discussing how the findings inform patient care. These consultations commonly occur between laboratory-based pathologists and clinicians managing patients in hospital or outpatient settings.
Report 80506 with the primary high-level consultation code 80505, not as a stand-alone service. Documentation should support the consultation work, time, records or results reviewed, and communication with the treating clinician. CMS classifies the service as an add-on paid within the primary procedure’s global period. The service has professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff, and an unmodified claim represents the global service.
CMS billing rules for 80506
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU0.80 · 64%
- Practice expense (office) RVU0.40 · 32%
- Malpractice RVU0.05 · 4%
25.4K
Medicare services in 2024 · #1045 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.
80506 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$52.13
80504 represents a moderate consultation. Use 80506 only for prolonged time beyond the primary high-level service.
$96.08
80505 reports the primary high-level consultation; 80506 is the add-on for prolonged consultation time and cannot replace it.
Compare 80506 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
Rhode Island →
Office / nonfacility
$42.52
Facility
Unavailable
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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 80506 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
9,737
- Code
- 80506
- Physician work
- 0.80
- Practice expense
- 0.40
- Malpractice
- 0.05
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.80 | × 1.019 | 0.8152 |
| Practice expense | 0.40 | × 1.033 | 0.4132 |
| Malpractice | 0.05 | × 0.892 | 0.0446 |
| Total RVUs | 1.2730 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$42.52
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.8 | 1.019 |
| Practice expense | 0.4 | 1.033 |
| Malpractice | 0.05 | 0.892 |
(0.8 × 1.019 + 0.4 × 1.033 + 0.05 × 0.892) × $33.4009 = $42.52
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.
80506 billing questions
When should 80506 be reported instead of 80505?
Use 80505 for the initial high-level clinical pathology consultation. Report 80506 for qualifying prolonged consultation time as an add-on to that primary service.
Can 80506 be billed by itself?
No. It is an add-on code and must be reported with its primary service, 80505.
What documentation supports 80506?
Record the consultation work and time, the laboratory results or other diagnostic information reviewed, and the discussion or recommendations communicated to the treating clinician.
How do modifiers 26 and TC relate to this code?
Modifier 26 identifies the professional interpretation, while TC identifies the technical portion involving equipment and staff. Billing without a modifier represents the global service.
How many units of 80506 should be reported?
Report units based on the prolonged consultation time supported in the record and the code’s additional-time increment. Do not use 80506 to represent the initial consultation.
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.
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
9,73680505,,Path clin consltj high 41-60,A,,1.71,1.02,,0.40,,0.09,2.82,2.20,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,73780506,,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
9,74081002,,Urinalysis nonauto w/o 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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537