Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 80185 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.
Seizure Medication Monitoring, Lab Blood Test To Ensure Therapeutic Dosing Of Anticonvulsant Drug. 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 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.25 national lab fee schedule rate (2026) · View Medicare rates for 80185 |
| Medicaid Fee Schedule | $13.085 median of the 8 states in the free preview · View Medicaid rates for 80185 |
National average reimbursement for CPT 80185 by major payers:
$11.68
$9.58
$15.65
$19.64
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 80185.
CPT 80185
5 of 25 sample ratesHigher to lower in this preview
Gamal Mostafa
North Shore-Lij Medical PC
$31.36Published ratePaula Beers
Betsy Beers Md PA
$7.94Published ratePulmonary And Critical Care Consultants Inc
$6.65Published rateVanitha Vasudevan
$5.57Published rateShirin Razdan
Ssr Consultants Inc
$4.63Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 80185 vs. Other Therapeutic Drug Assays Codes
The CPT 80185 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 80185 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 |
|---|---|---|
| 80178-CPT | Low | Lithium Dosage Assessment, Lithium Is A Naturally Occurring Mineral Used To Treat Bipolar Disorder (Manic-Depression). This Test Helps Determine The Proper Dose For Therapy. |
| 80180-CPT | Low | Medication Monitoring, Mycophenolate Typically Is Used With Other Medicines To Keep The Body From Rejecting An Organ Transplant And Is Also Used To Treat Autoimmune Diseases. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80184-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. |
| 80185-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 80185. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80185 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 80185) and we'll show you how you compare in 15 minutes or less.