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See a sample rate comparisonCPT 80163 Fee Schedule
Last Verified: October 2026
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.
Heart Drug Therapy Monitoring, This Analysis Monitors Drug Therapy For Heart Conditions. Blood Samples Are Measured Shortly After A Drug Is Taken And Approximately 12 Hours Later To Determine Correct Dosage.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.28 national lab fee schedule rate (2026) · View Medicare rates for 80163 |
| Medicaid Fee Schedule | $13.115 median of the 8 states in the free preview · View Medicaid rates for 80163 |
National average reimbursement for CPT 80163 by major payers:
$12.15
$9.52
$13.94
$45.52
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CPT 80163
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$29.22Published rateMaricopa County Special Health Care District, Valleywise Health
$15.93Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$13.43Published rateChildrens National Medical Center
Childrens Hospital
$7.97Published rateBrittany Ptachick
Hroa 401k Plan
$5.58Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80163 vs. Other Therapeutic Drug Assays Codes
The CPT 80163 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 80163 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 |
|---|---|---|
| 80156-CPT | Low | Seizure Medication Monitoring, Lab Blood Test To Ensure Therapeutic Dosing Of Anticonvulsant Drug. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80157-CPT | Low | Seizure Medication Monitoring, Lab Blood Test To Ensure Therapeutic Dosing Of Anticonvulsant Drug. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80161-CPT | Low | Seizure Medication Monitoring, Lab Blood Test To Ensure Therapeutic Dosing Of Anticonvulsant Drug. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80163-CPT | Low | Heart Drug Therapy Monitoring, This Analysis Monitors Drug Therapy For Heart Conditions. Blood Samples Are Measured Shortly After A Drug Is Taken And Approximately 12 Hours Later To Determine Correct Dosage. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80163. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80163 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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