Consultation on Referred Specimens (D0485) — National Rates

About D0485 — Consultation on Referred Specimens

D0485 refers to Consultation on Referred Specimens, where a pathologist provides an expert opinion on tissue samples sent from another healthcare provider. This service is crucial for complex cases where additional expertise is required to interpret findings. Clinical indications for this procedure include unusual or challenging cases that may benefit from a specialist's insight. When billing for D0485, it is important to document the clinical history, the reason for the referral, and the pathologist's conclusions. The average reimbursement for this service is around $267, but it can vary significantly by payor and state. Some insurance plans may have specific criteria for coverage, and it is advisable to verify these details to ensure proper reimbursement.

Reimbursement rates for D0485 vary significantly by state, payor, and provider network. The national average negotiated rate is $267. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.