CPT 80173 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 None |
| Common Modifiers | None 90 - Reference Laboratory QJ - Services/items provided to a prisoner or patient in state or local custody |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80173 |
| Medicaid Fee Schedule | View Medicaid rates for 80173 |
National average reimbursement for CPT 80173 by major payers:
$13.67
$11.01
$17.96
$23.32
CPT 80173 vs. Other Therapeutic Drug Assays Codes
The CPT 80173 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 80173 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 |
|---|---|---|
| 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. |
| 80176-CPT | Low | Lidocaine Dose Assessment, This Is A Blood Test To Measure The Amount Of Lidocaine Over Time. It Can Help Determine Correct Dose And Therapeutic Effectiveness. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80173. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80173 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 80173) and we'll show you how you compare in 15 minutes or less.