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See a sample rate comparisonCPT 80190 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.
Heart Medication Assessment, Both Procainamide And Quinidine Are Used To Treat Life-Threatening Heart Conditions. Periodic Assessment Monitors Potential Side Effects Ensures The Lowest Therapeutic Dose And Evaluates Treatment Effectiveness.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $60.00 national lab fee schedule rate (2026) · View Medicare rates for 80190 |
| Medicaid Fee Schedule | $55.20 median of the 8 states in the free preview · View Medicaid rates for 80190 |
National average reimbursement for CPT 80190 by major payers:
$42.13
$26.74
$48.81
$81.02
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CPT 80190
5 of 25 sample ratesHigher to lower in this preview
St. Luke'S Community Health Services, St. Luke'S The Woodlands Hospital
St Lukes Community Health Services
$90.00Published rateWaccamaw Community Hospital, Tidelands Waccamaw Community Hospital
Waccamaw Community Hospital
$60.00Published ratePrisma Health-Upstate, Prisma Health Op Surgery Patewood
Prisma Health - Upstate
$54.00Published rateChristopher Raio
Mercy Medical Center
$22.96Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$9.35Published rate
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See a sample payer proposalCPT 80190 vs. Other Therapeutic Drug Assays Codes
The CPT 80190 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 80190 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 |
|---|---|---|
| 80190-CPT | Low | Heart Medication Assessment, Both Procainamide And Quinidine Are Used To Treat Life-Threatening Heart Conditions. Periodic Assessment Monitors Potential Side Effects Ensures The Lowest Therapeutic Dose And Evaluates Treatment Effectiveness. |
| 80192-CPT | Low | Heart Medication Assessment, Both Procainamide And Quinidine Are Used To Treat Life-Threatening Heart Conditions. Periodic Assessment Monitors Potential Side Effects Ensures The Lowest Therapeutic Dose And Evaluates Treatment Effectiveness. |
| 80193-CPT | Low | Leflunomide Monitoring, This Test Measures The Therapeutic Level Of Leflunomide A Drug That Is Used To Treat Rheumatoid Arthritis In Adults. |
| 80194-CPT | Low | Heart Medication Assessment, Both Procainamide And Quinidine Are Used To Treat Life-Threatening Heart Conditions. Periodic Assessment Monitors Potential Side Effects Ensures The Lowest Therapeutic Dose And Evaluates Treatment Effectiveness. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80190. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80190 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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