CPT Code 80200

2026 CLFS pricing

CPT 80200 is not priced under the Physician Fee Schedule (status X). Laboratory tests are reimbursed under the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule. Actual payment is the lesser of the billed charge or this national limit, and some states' fee schedules differ.

Common ICD-10 diagnoses billed with 80200

Diagnoses frequently paired with 80200 on claims. A relevant diagnosis helps support medical necessity, but it does not by itself guarantee payment. Documentation, the service performed, and payer/CMS policy all apply. Link each line item to the diagnosis that best documents why the service was needed.

• E78.0Metabolic condition 0 for 80200
• E78.1Metabolic condition 1 for 80200
• E78.2Metabolic condition 2 for 80200
• E78.3Metabolic condition 3 for 80200
• E78.4Metabolic condition 4 for 80200
• E78.5Metabolic condition 5 for 80200
• E78.6Metabolic condition 6 for 80200
• E78.7Metabolic condition 7 for 80200

Laboratory pricing note

Clinical laboratory tests like 80200 are generally reimbursed under the Medicare Clinical Laboratory Fee Schedule (CLFS), which sets a national limitation amount per test rather than RVU-based PFS pricing. Bill the test on a CMS-1500/837P with the ordering diagnosis; payment follows the CLFS amount for the date of service.

Related Pathology & Laboratory codes

Related guides

• The ICD-10 Codes That Get Primary Care Claims Denied (and How to Pick the Right One)