Billing code 80503: Pathology consultationMedicare rate & RVUs in Texas
Reports a pathologist’s straightforward clinical consultation to assess patient-specific laboratory findings and advise the treating clinician, generally over 5–20 minutes.
Medicare pays $25.32–$27.00 for 80503 in the office in Texas, from Beaumont to Austin. 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 80503 covers
A clinical pathology consultation is a pathologist’s assessment of patient-specific laboratory information in response to a clinical question. The pathologist may review test results and relevant medical records, consider whether additional testing is appropriate, and communicate an interpretation or recommendation to the treating clinician. Consultations commonly address unclear, conflicting, or unexpected laboratory findings; the service is the pathologist’s clinical reasoning and advice, not the performance of the laboratory tests themselves.
Choose this level when the consultation meets the straightforward medical decision-making description or the stated 5–20-minute time range. Document the requesting clinician’s question, the relevant records and results reviewed, the pathologist’s analysis, and the advice communicated. When selecting by time, record the consultation time supporting the level. Report a higher-level family code when the consultation’s decision-making or time fits that code instead.
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 80503 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$25.32 to $27.00
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $27.00 | $18.52 |
| Beaumont | $25.32 | $18.02 |
| Brazoria | $26.25 | $18.31 |
| Dallas | $26.38 | $18.39 |
| Fort Worth | $26.27 | $18.37 |
| Galveston | $26.31 | $18.35 |
| Houston | $26.67 | $18.71 |
| Rest Of Texas | $25.74 | $18.14 |
How the 80503 rate is calculated
Each of 80503’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 · 80503
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.43Practice expense 0.34Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 80503
80503 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 · 80503
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$26.39
The facility rate would be $18.37 (+$8.02). In a facility, the facility bills its own costs separately.
80503 compared with similar codes
Compare codes
80503 vs 80504 vs 80505 vs 80506: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 80504Pathology consult
- Choose 80504 when the consultation meets moderate medical decision-making or the 21–40-minute time range; 80503 is the straightforward, 5–20-minute level.
- 80505Clinical pathology consult
- Choose 80505 for high medical decision-making or the 41–60-minute time range. A straightforward consultation fits 80503 instead.
- 80506Pathology consultation
- 80506 identifies prolonged service within this consultation family. 80503 describes the straightforward base consultation level and its stated time range.
80503 billing questions
How does 80503 differ from 80504?
80503 is for a straightforward consultation with 5–20 minutes of service. Use 80504 when the consultation meets the moderate medical decision-making level or its stated 21–40-minute time range.
Can 80503 be reported for routine laboratory result review?
The service is a patient-specific clinical consultation, not routine review associated with laboratory testing. Document the clinical question and the pathologist’s consultative assessment and advice.
What should the consultation documentation show?
Record who requested the consultation, the clinical issue, the relevant results and records reviewed, the pathologist’s reasoning, and the recommendation communicated. Include time when using time to support code selection.
Does 80503 include performing the laboratory test?
No. It represents the pathologist’s consultative work; it is not a code for collecting a specimen, running an assay, or reporting the test result alone.
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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