Priced under CLFS
80053 · PFS Q4 2025 · Historical
Status X is not separately payable under the PFS.
CMS RVU25DOctober 1 – December 31, 2025
PFS status evidence
Inspect PFS status evidence
- Code
- 80053
- Release
- Q4 2025, revision 1
- Result
- Priced under CLFS
Citations
-
Shows this code’s PFS status (X). Result: Priced under CLFS.
Physician relative value file (PPRRVU)CMS RVU25DOctober 1 – December 31, 2025
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2025_Oct.csv row 9,408 in rvu25d-updated-09-11-2025.zip
In the CMS file
Loading rows 9,406–9,410 of PPRRVU2025_Oct.csv…
Download rvu25d-updated-09-11-2025.zip from CMS File fingerprint
8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56
CPT 80053 has no published national rate. It carries status X (statutory exclusion) in the Q4 2025 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 80053?
Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.
About this code
One blood test measuring a standard group of substances: blood sugar, salts and minerals, and markers of kidney and liver function. It gives a broad check on several organ systems at once. Medicare reported 27.2 million services under this code in CY2024.
Plain-language context only—not the official CPT descriptor and not coding guidance
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust 80053's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 80053 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU25DOctober 1 – December 31, 2025
Can you bill it with another code? Copy link
Payment review for 80053 Copy link
What to check (3)
Lab panels, their component tests, and specimen collection can be paid under different rules and schedules. Compare like with like, and keep the panel line separate from the blood draw.
- Use the CLFS amount for the lab test instead of reading a blank PFS amount as zero.
- Check component bundling and repeat-test rules against the NCCI edits in effect on the date of service.
- Bill 36415 as its own collection line, and don’t multiply it by the number of tests in the panel.
Sources: CMS Clinical Laboratory Fee Schedule; CMS Medicare NCCI Policy Manual (2026); CMS Medicare Claims Processing Manual (Pub. 100-04).
Source & method Copy link
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01 PPRRVU2025_Oct.csv · Q4 2025 (RVU25D) · row 9,408—status X, RVUs limits
- Effective
- October 1 – December 31, 2025
- Locator
- PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip · row 9,408 of 19,090 · via CMS
- Fields read
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Status X (col 4)SHA-256 8af460f38bf982b7…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
-
02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q4 2025 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume, or the exact place of service: CMS publishes only the facility vs non-facility split, so the Office (non-facility) share does not identify urgent care or any other specific setting.
- Note
- The dataset suppresses rows under 11 beneficiaries. Specialty groups with fewer than 30 observed clinicians are omitted, so the shares can fall short of 100%.
Cite this rate
CPT 80053 National PFS baseline: No national PFS rate (Q4 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25D, PPRRVU2025_Oct.csv row 9,408. Localis. https://localishealth.com/cpt/80053/2025/D
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
— Office (non-facility) and — Facility since Jan 1, 2013.
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Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- —
- Facility
- —
-
Jan 1, 2013 – present
Q1 2013
Still in effect · 53 releases at this rate- Office
- —
- Facility
- —
Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013 · Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014 · Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015 · Q4 2015 Oct 1, 2015 – Dec 31, 2015 · Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016 · Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017 · Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018 · Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019 · Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020 · Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021 · Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022 · Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023 · Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Usage and related codes Copy link
In CY2024, 80053 ranked #5 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 27.2M
- Allowed
- $281.2M
- Beneficiaries
- 13.1M
Who bills 80053 to Medicare
100% Office (non-facility) · 0% facility- Hematology/Oncology 23%
- Family Medicine 22%
- Internal Medicine 21%
- Pathology 12%
- NP/PA 11%
CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.