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See a sample rate comparisonCPT 80197 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.
Immune Suppressant Monitoring, Monitoring Of An Immune Suppressant Drug To Help Prevent Transplant Rejection.
| 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 | 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.73 national lab fee schedule rate (2026) · View Medicare rates for 80197 |
| Medicaid Fee Schedule | $12.695 median of the 8 states in the free preview · View Medicaid rates for 80197 |
National average reimbursement for CPT 80197 by major payers:
$12.02
$10.32
$17.30
$20.32
Compare published rates across providers.
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CPT 80197
5 of 25 sample ratesHigher to lower in this preview
Overlook Hospital
Atlantic Health System Inc
$20.39Published rateIman Washington
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$8.23Published rateJohn Greene
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$8.23Published rateMaritza Klaiber
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$7.00Published rateAlly Neal
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$7.00Published rate
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See a sample payer proposalCPT 80197 vs. Other Therapeutic Drug Assays Codes
The CPT 80197 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 80197 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 |
|---|---|---|
| 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. |
| 80197-CPT | Low | Immune Suppressant Monitoring, Monitoring Of An Immune Suppressant Drug To Help Prevent Transplant Rejection. |
| 80199-CPT | Low | Medication Monitoring, Tiagabine Is An Anticonvulsant Typically Used To Treat Seizures. Periodic Monitoring Evaluates Dosage Adverse Effects And Interactions With Other Drugs. |
| 80203-CPT | Low | Medication Monitoring, Zonisamide Is An Anticonvulsant Typically Used To Treat Seizures. 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 80197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80197 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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