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See a sample rate comparisonCPT 80199 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.
Medication Monitoring, Tiagabine Is An Anticonvulsant Typically Used To Treat Seizures. 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 TC - Technical component 52 - Reduced Services 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $27.11 national lab fee schedule rate (2026) · View Medicare rates for 80199 |
| Medicaid Fee Schedule | $24.94 median of the 8 states in the free preview · View Medicaid rates for 80199 |
National average reimbursement for CPT 80199 by major payers:
$21.78
$15.43
$24.78
$63.39
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CPT 80199
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$59.64Published rateAshley O'Connor
Atlantic Health System Inc
$27.64Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$17.62Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$14.64Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$10.33Published rate
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See a sample payer proposalCPT 80199 vs. Other Therapeutic Drug Assays Codes
The CPT 80199 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 80199 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 |
|---|---|---|
| 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. |
| 80204-CPT | Low | Methotrexate Monitoring, This Test Measures The Therapeutic Level Of Methotrexate A Drug Used In The Treatment Of Rheumatoid Arthritis And Certain Types Of Cancer. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80199 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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