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See a sample rate comparisonCPT 80167 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.
Felbamate Monitoring, This Test Measures The Therapeutic Level Of Felbamate Present In Blood And Urine Samples. Felbamate Is Typically Used To Control Seizures.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $18.64 national lab fee schedule rate (2026) · View Medicare rates for 80167 |
| Medicaid Fee Schedule | $17.145 median of the 8 states in the free preview · View Medicaid rates for 80167 |
National average reimbursement for CPT 80167 by major payers:
$14.66
$11.42
$18.64
$48.19
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CPT 80167
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$41.01Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$18.64Published rateMichael Shuler
Athens Orthopedic Clinic, PA
$11.18Published rateAnn Steck
Toledo Hospital
$10.05Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$7.46Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80167 vs. Other Therapeutic Drug Assays Codes
The CPT 80167 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 80167 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. |
| 80167-CPT | Low | Felbamate Monitoring, This Test Measures The Therapeutic Level Of Felbamate Present In Blood And Urine Samples. Felbamate Is Typically Used To Control Seizures. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80167. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80167 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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