CPT 80185 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 | Therapeutic Drug Assays Pathology and Laboratory Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80185 |
National average reimbursement for CPT 80185 by major payers:
$11.68
$9.58
$15.65
$19.64
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 80185 | $7.94 | 1902284177 - MELIA HOLT | 592198263 - THE DERMATOLOGY GROUP, P.A. | FL | Dermatology Physician (207N00000X) |
United | 80185 | $7.78 | 1396797437 - A ENRIQUE WHITTWELL MD PA | 650149079 - (FL) A ENRIQUE WHITTWELL MD PA | FL | Surgery Physician (208600000X) |
United | 80185 | $5.57 | 1669474805 - KAY SHAWCHUCK | 901005885 - (FL) GREATER TAMPA BAY PHYSICIAN SPECIALISTS LLC | FL | Surgery Physician (208600000X) |
United | 80185 | $6.65 | 1083815468 - PULMONARY AND CRITICAL CARE CONSULTANTS INC | 650715144 - (FL) PULMONARY AND CRITICAL CARE CONSULTANTS INC | FL | Pulmonary Disease Physician (207RP1001X) |
United | 80185 | $15.06 | 1154815546 - FOREFRONT DERMATOLOGY, S.C., ADVANCED DERMATOLOGY & SKIN CARE CENTRE | 391351587 - FOREFRONT DERMATOLOGY, S.C. | FL | Dermatology Physician (207N00000X) |
United | 80185 | $10.84 | 1154795052 - SAKETH PALASAMUDRAM SHEKAR | 834448194 | FL | Pulmonary Disease Physician (207RP1001X) |
United | 80185 | $7.55 | 1699870642 - RUXANA SADIKOT | 470785575 - (NE) UNMC PHYSICIANS | FL | Pulmonary Disease Physician (207RP1001X) |
United | 80185 | $5.57 | 1952524274 - CHRISTOPHER DIBLASIO | 133439470 | FL | Urology Physician (208800000X) |
United | 80185 | $5.57 | 1306878764 - ROY MASON | 590637874 - MARTIN MEMORIAL MEDICAL CENTER INC | FL | Urology Physician (208800000X) |
United | 80185 | $4.63 | 1114914934 - FRANCISCO FLORES | 834572995 - (FL) THE DERM GROUP LLP | FL | Dermatology Physician (207N00000X) |
United | 80185 | $6.78 | 1245275569 - OREN LIFSHITZ | 650846826 - (FL) PBDP INC | FL | Dermatology Physician (207N00000X) |
United | 80185 | $6.32 | 1104913185 - WILLIAM PORTNOY | 650790741 - (FL) EAR NOSE THROAT OF SF | FL | Otolaryngology Physician (207Y00000X) |
United | 80185 | $5.57 | 1639313315 - VANITHA VASUDEVAN | 272777455 | FL | Surgery Physician (208600000X) |
United | 80185 | $5.57 | 1023041126 - QUAN TRAN | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Surgery Physician (208600000X) |
United | 80185 | $10.81 | 1629413042 - MOHAMAD HAMMOUD | 461243081 | FL | Surgery Physician (208600000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 80185 vs. Other Pathology and Laboratory Procedures Codes
The CPT 80185 code is part of the Therapeutic Drug Assays services used for Pathology and Laboratory Procedures. 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.
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