CPT 80164 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 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80164 |
| Medicaid Fee Schedule | View Medicaid rates for 80164 |
National average reimbursement for CPT 80164 by major payers:
$11.84
$10.31
$16.18
$20.19
CPT 80164 vs. Other Therapeutic Drug Assays Codes
The CPT 80164 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 80164 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. |
| 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. |
| 80164-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. |
| 80165-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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80164. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80164 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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