CPT 80193 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 | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 90 - Reference Laboratory PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80193 |
| Medicaid Fee Schedule | View Medicaid rates for 80193 |
National average reimbursement for CPT 80193 by major payers:
$30.79
$23.08
$38.57
$74.45
CPT 80193 vs. Other Therapeutic Drug Assays Codes
The CPT 80193 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 80193 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. |
| 80189-CPT | Low | Itraconazole Monitoring, This Test Measures The Therapeutic Level Of Itraconazole A Drug That Is Typically Used To Treat A Fungal Infection. |
| 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. |
| 80193-CPT | Low | Leflunomide Monitoring, This Test Measures The Therapeutic Level Of Leflunomide A Drug That Is Used To Treat Rheumatoid Arthritis In Adults. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80193. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80193 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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