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See a sample rate comparisonCPT 80175 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, Lamotrigine Typically Is Used To Treat Mood Disorders And Certain Types Of Seizures. 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 11 - Office |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.25 national lab fee schedule rate (2026) · View Medicare rates for 80175 |
| Medicaid Fee Schedule | $13.085 median of the 8 states in the free preview · View Medicaid rates for 80175 |
National average reimbursement for CPT 80175 by major payers:
$11.73
$9.60
$14.92
$43.95
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CPT 80175
5 of 25 sample ratesHigher to lower in this preview
Kelley Parnell
Neuroscience Group Of Northeast Wisconsin, S.C.
$33.04Published ratePeggy Brokl
Neuroscience Group Of Northeast Wisconsin, S.C.
$32.63Published rateColumbia Plaza Medical Center Of Fort Worth Subsidiary Lp, Medical City Fort Worth
Columbia Plaza Medical Center Of Fort Worth Subsidiary Lp
$13.25Published ratePrisma Health-Upstate, Prisma Health Transplant Center
Prisma Health - Upstate
$11.93Published rateMethodist Hospital Plainview Texas, Covenant Hospital Plainview
Methodist Hospital Plainview Texas
$6.19Published rate
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See a sample payer proposalCPT 80175 vs. Other Therapeutic Drug Assays Codes
The CPT 80175 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 80175 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 |
|---|---|---|
| 80162-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. |
| 80175-CPT | Low | Medication Monitoring, Lamotrigine Typically Is Used To Treat Mood Disorders And Certain Types Of Seizures. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 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. |
| 80177-CPT | Low | Medication Monitoring, Levetiracetam Typically Is Used To Treat Certain Types Of Seizures Caused By Epilepsy. 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 80175. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80175 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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