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See a sample rate comparisonCPT 80188 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 11 - Office |
| Common Modifiers | 90 - Reference Laboratory PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.59 national lab fee schedule rate (2026) · View Medicare rates for 80188 |
| Medicaid Fee Schedule | $16.385 median of the 8 states in the free preview · View Medicaid rates for 80188 |
National average reimbursement for CPT 80188 by major payers:
$14.66
$12.07
$18.48
$24.15
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CPT 80188
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$22.74Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$16.78Published rateColumbia Medical Center Of Arlington Subsidiary Lp, Medical City Arlington
Columbia Medical Center Of Arlington Subsidiary Lp
$16.59Published rateNorthwest Texas Surgical Hospital, LLC, Northwest Texas Surgery Center
Northwest Texas Surgical Hospital LLC
$6.96Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80188 vs. Other Therapeutic Drug Assays Codes
The CPT 80188 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 80188 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 |
|---|---|---|
| 80181-CPT | Low | Flecainide Monitoring, This Test Measures The Therapeutic Level Of Flecainide Present In Blood And Urine Samples. Flecainide Is Typically Used To Prevent And Treat Abnormally Fast Heart Rates. |
| 80183-CPT | Low | Medication Monitoring, Oxcarbazepine Typically Is Used To Treat Seizures Caused By Epilepsy. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80188-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. |
| 80200-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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80188. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80188 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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