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Describe a service in plain words, or type a CPT/HCPCS code.

CPT 80061 Medicare payment status

Cholesterol Blood Panel

Priced under CLFS

80061 · PFS Q3 2026 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU26CJuly 1 – September 30, 2026

PFS status evidence

Inspect PFS status evidence
Code
80061
Release
Q3 2026, revision 1
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)CMS RVU26CJuly 1 – September 30, 2026

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU2026_Jul_nonQPP.csv row 9,531 in rvu26c-updated-06-30-2026.zip

    In the CMS file

    Loading rows 9,529–9,533 of PPRRVU2026_Jul_nonQPP.csv…

    Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Plain-text summaryReport a problem

CPT 80061 has no published national rate. It carries status X (statutory exclusion) in the Q3 2026 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 80061?

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

Also known as Cholesterol test

A blood test measuring cholesterol and other fats, reported as total cholesterol, HDL, LDL, and triglycerides. It helps gauge heart and blood-vessel risk. Medicare reported 17.3 million services under this code in CY2024.

Plain-language context only—not the official CPT descriptor and not coding guidance

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Other payment indicators (8)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Contractor pricing: Does not apply.
Why would a Medicare claim for 80061 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
  • 8 codes form NCCI pairs with 80061 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 6 codes pair with 80061 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together

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.

Which billing rules and modifiers apply? Copy link

Global period: what 80061's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for 80061 →

Billing together (NCCI edits) Copy link

NCCI Q3 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 80061 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

0002M 80061 denies
0003M 80061 denies
0166U 80061 denies

Showing 3 of 8.

Separately payable with 80061 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

80503 80503 denies
80504 80504 denies
80505 80505 denies

Showing 3 of 6.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 14 NCCI pairs →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 80061 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present X — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X — —
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.

Usage and related codes Copy link

How often 80061 is billed Copy link

Across Original Medicare in CY2024, 80061 ranked #10 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.5 times on average that year.

Beneficiaries
11.5M
Office + facility beneficiaries combined
Services
17.3M
Times it was billed
Allowed
$227.0M
Total Medicare allowed dollars
Compare: ↑ #9 more popular · 66984 ↓ #11 less popular · 99204

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q3 2026 fee schedule above.

Who bills 80061 to Medicare

Observed CY2024 Medicare fee-for-service billing, by the rendering clinician's CMS specialty. Each share is that specialty's slice of all observed services for this code that year.

Family Medicine
37%
Internal Medicine
34%
NP/PA
12%
Pathology
7%
Endocrinology
4%

Setting split that year: 100% Office (non-facility) · 0% facility. CMS publishes only this facility vs non-facility split, never the exact place of service. The Office (non-facility) figure does not identify urgent care or any other specific setting.

CY2024 Medicare fee-for-service only, from the CMS Physician & Other Practitioners dataset, which suppresses rows under 11 beneficiaries. We omit specialty groups with fewer than 30 observed clinicians, so the shares can fall short of 100%. Specialty and practice-type pages linked elsewhere on this page are curated code lists, not utilization claims.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 80061 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 9,531. Localis. https://localishealth.com/cpt/80061/2026/C