How much does Medicare pay for CPT 80503?

Medicare allowed an average of $22.43 per service and paid $16.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $86.92, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 80503?

Pathology clinical consultation for clinical problem, 5-20 minutes. It was billed 22,587 times to 20,036 Medicare beneficiaries by 244 providers in 2024.

Does 80503 pay differently in an office than a hospital?

Yes. The allowed amount averaged $27.36 in an office setting and $20.98 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 80503 most?

Pathology, with 19,502 services from 231 clinicians. Next are Clinical Laboratory, Hematology, Pediatric Medicine.

CPT 80503

Pathology clinical consultation for clinical problem, 5-20 minutes

$22.43Medicare-allowed amount per service, averaged across 22,587 services

Providers submitted

$86.92

Asking price, not received

Medicare allowed

$22.43

The fee schedule figure

Medicare paid

$16.80

Balance is patient coinsurance

Providers submitted an average of $86.92 for this code and Medicare allowed $22.43 — 3.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $16.80 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $27.36
Hospital / facility: $20.98

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,149 services were billed in an office setting and 17,438 in a facility.

Services: 22,587
Beneficiaries: 20,036
Providers billing it: 244
Total allowed: $506,626

What Medicare pays for CPT 80503

Across 22,587 services billed by 244 providers to 20,036 beneficiaries, Medicare allowed an average of $22.43 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 80503

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pathology	19,502	17,246	$21.58	231
Clinical Laboratory	2,756	2,496	$28.51	6
Hematology	231	212	$21.06	3
Pediatric Medicine	37	26	$25.62	1
General Surgery	26	26	$23.59	1
Hematology-Oncology	23	18	$22.17	1
Internal Medicine	12	12	$21.74	1

80503 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Tennessee	3,346	$19.82	$16.28	8
Michigan	2,165	$21.67	$15.93	20
Oklahoma	1,933	$22.70	$17.56	9
Texas	1,571	$21.25	$16.81	32
Virginia	1,390	$28.44	$19.20	4
Florida	1,185	$21.33	$16.54	19
New York	1,169	$22.17	$16.26	19
Louisiana	1,057	$20.67	$16.59	4
New Jersey	951	$27.05	$18.72	4
Washington	907	$26.57	$16.96	6
North Carolina	906	$20.53	$16.36	3
Iowa	685	$20.23	$15.20	5
Illinois	591	$22.11	$16.61	4
Pennsylvania	544	$21.11	$15.98	15
Massachusetts	512	$25.46	$16.57	12
Oregon	431	$25.84	$15.81	1
Ohio	388	$21.37	$16.18	13
California	385	$24.48	$16.79	14
South Carolina	333	$21.17	$16.37	4
Maryland	326	$25.09	$17.34	5
Minnesota	326	$21.17	$16.17	10
Colorado	323	$24.27	$18.26	6
Nebraska	265	$22.21	$16.76	3
Mississippi	197	$21.17	$16.92	3
Alabama	143	$20.20	$16.50	6
Missouri	141	$20.89	$16.43	3
Arizona	124	$20.98	$13.99	3
South Dakota	91	$22.74	$17.49	3
Indiana	67	$23.69	$17.66	2
Maine	54	$20.36	$16.86	1
Kansas	31	$20.34	$14.30	1
New Hampshire	26	$22.68	$16.43	1
District of Columbia	24	$20.59	$16.97	1

Related codes

80505Pathology clinical consultation for complex clinical problem$95.40
80504Pathology clinical consultation for moderately complex clinical proble$46.89

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.