CPT 80151 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80151 |
| Medicaid Fee Schedule | View Medicaid rates for 80151 |
National average reimbursement for CPT 80151 by major payers:
$14.66
$11.42
$18.62
$48.18
CPT 80151 vs. Other Therapeutic Drug Assays Codes
The CPT 80151 code is part of the Pathology and Laboratory Procedures services used for Therapeutic Drug Assays. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 80151 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 80143-CPT | Low | Check Acetaminophen Level, The Test Measures The Therapeutic Level Of Acetaminophen In A Blood Sample. It Can Help Assess Whether Levels Are Toxic And If There Is Potential For Liver Damage. |
| 80145-CPT | Low | Adalimumab, A Lab Test For Adalimumab. This Drug Typically Is Given To Treat Rheumatoid Arthritis Psoriasis Or Inflammatory Bowel Disease. |
| 80151-CPT | Low | Amiodarone Monitoring, Lab Blood Test To Ensure Therapeutic Levels Of Amiodarone A Drug Used To Treat Problems With Heart Rhythm. |
| 80155-CPT | Low | Stimulant Analysis (Caffeine), Caffeine Is A Drug That Stimulates The Central Nervous System. A Lab Test Performed On A Urine Sample Will Show The Level Of Caffeine In The Body. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80151. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80151 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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