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See a sample rate comparisonCPT 80171 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.
Medication Monitoring, Gabapentin Typically Is Used To Treat Certain Types Of Seizures Restless Legs Syndrome (Rls) And Pain Caused By Shingles (Postherpetic Neuralgia). Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $21.67 national lab fee schedule rate (2026) · View Medicare rates for 80171 |
| Medicaid Fee Schedule | $19.935 median of the 8 states in the free preview · View Medicaid rates for 80171 |
National average reimbursement for CPT 80171 by major payers:
$16.53
$12.41
$21.32
$59.35
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CPT 80171
5 of 25 sample ratesHigher to lower in this preview
Tiziana Califano
Atlantic Health System Inc
$28.96Published rateMelanie Smith
Atlantic Health System Inc
$21.72Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$13.40Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$13.00Published rateProgressive Emergency Physicians PLLC
$6.58Published rate
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See a sample payer proposalCPT 80171 vs. Other Therapeutic Drug Assays Codes
The CPT 80171 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 80171 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 |
|---|---|---|
| 80168-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. |
| 80170-CPT | Low | Antibiotic Monitoring, Lab Blood Test To Ensure Therapeutic Levels Of An Antibiotic. Monitoring Ensures Levels Are High Enough To Treat The Infection But Low Enough To Avoid Toxicity. |
| 80171-CPT | Low | Medication Monitoring, Gabapentin Typically Is Used To Treat Certain Types Of Seizures Restless Legs Syndrome (Rls) And Pain Caused By Shingles (Postherpetic Neuralgia). Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80173-CPT | Low | Haloperidol Drug Level, Haloperidol Is An Antipsychotic Used To Treat Severe Conditions Such As Schizophrenia And Delirium. Levels Are Monitored To Determine Correct Therapy Dose As Well As To Ensure It Is Not Interfering With Any Other Drug Therapies Being Used. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80171. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80171 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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