Summary & Overview
CPT 80504: Pathology Consultation for Moderate Complexity
CPT code 80504 designates a pathologist consultation for a moderately complex clinical problem that requires a moderate level of medical judgment. The service includes review of the patient’s history and medical records and can be reported when 21–40 minutes of consultation time are documented. This code matters nationally because pathology consultations play a central role in clarifying diagnostic test findings that affect clinical decisions across inpatient and outpatient settings.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical scope, common billing considerations, and the payer landscape for coverage and reimbursement. The publication summarizes typical sites of service and the clinical context in which the code is used, plus a review of common modifiers and administrative notes relevant to billing workflows. Policy updates and benchmark information, when available, are summarized to give readers a sense of how this consultation code is positioned within contemporary practice.
Billing Code Overview
CPT code 80504 describes a pathologist consultation performed at the request of a physician or other qualified healthcare provider for a moderately complex clinical problem. The service requires a moderate level of medical judgment and includes review of patient history and medical records. The code may also be selected when 21–40 minutes of consultation time are documented on the consultation date.
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Service type: Pathology consultation involving evaluation and interpretation for a moderately complex clinical problem
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Typical site of service: Usually furnished in inpatient or outpatient clinical settings where pathology consultations are requested, including hospital laboratories and outpatient pathology services
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a recent core needle liver biopsy has a pathology specimen with atypical findings. The treating hepatologist requests a pathology consultation to help interpret immunohistochemical stains, review the patient’s prior biopsy reports, imaging summaries, and clinical history, and to provide an expert diagnostic impression. The pathologist reviews the medical record, examines the slide set, correlates prior results, and documents 25 minutes of moderate-complexity medical judgment on the consultation date. The service is furnished at an outpatient pathology service within an ambulatory surgery center or hospital outpatient department, and may also occur as an interdepartmental consultation documented in the inpatient chart. Typical workflow includes chart retrieval, slide review, discussion with the requesting physician (phone or electronic), and issuance of a formal consultation addendum in the pathology report.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation portion of a service when technical component is billed separately. |
59 | Distinct procedural service |