$25.94
Choose 80503 for the lower-complexity consultation tier, rather than the moderate tier associated with 80504.
On this page
CMS RVU26D · Effective 2026-10-01
80504 Pathology consult Medicare reimbursement rates in Vermont
Reports a pathologist’s moderate-complexity consultation on a clinical laboratory question, associated with 21–40 minutes of service. Compare 80504 office and facility rates across CMS payment localities in Vermont.
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 80504 in Vermont?
Vermont 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
$50.09
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$37.85
1 of 1 localities have a supported rate.
Payment area: Vermont
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 80504: Moderate-complexity pathology consultation
Reports a pathologist’s moderate-complexity consultation on a clinical laboratory question, associated with 21–40 minutes of service.
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.
Where the value comes from
- Work RVU0.91 · 59%
- Practice expense (office) RVU0.57 · 37%
- Malpractice RVU0.05 · 3%
3.7K
Medicare services in 2024 · #2040 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.
80504 compared with similar codes
Office rates for Vermont, from the same CMS release.
$92.36
Choose 80505 when the consultation meets the high-complexity tier and its associated 41–60-minute band; 80504 is the moderate tier.
$40.79
80506 addresses prolonged consultation service, rather than the moderate-complexity base consultation represented by 80504.
Compare 80504 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
Vermont →
Office / nonfacility
$50.09
Facility
$37.85
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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 80504 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
9,735
- Code
- 80504
- Physician work
- 0.91
- Practice expense
- 0.57
- Malpractice
- 0.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.91 | × 1.000 | 0.9100 |
| Practice expense | 0.57 | × 0.990 | 0.5643 |
| Malpractice | 0.05 | × 0.506 | 0.0253 |
| Total RVUs | 1.4996 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$50.09
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.91 | 1 |
| Practice expense | 0.57 | 0.99 |
| Malpractice | 0.05 | 0.506 |
(0.91 × 1 + 0.57 × 0.99 + 0.05 × 0.506) × $33.4009 = $50.09
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.91 | 1 |
| Practice expense | 0.2 | 0.99 |
| Malpractice | 0.05 | 0.506 |
(0.91 × 1 + 0.2 × 0.99 + 0.05 × 0.506) × $33.4009 = $37.85
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.
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 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
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817