CPT 80202 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 | Therapeutic Drug Assays Pathology and Laboratory Procedures |
| Common Place of Service | 21 - Inpatient Hospital 81 - Independent Laboratory |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80202 |
National average reimbursement for CPT 80202 by major payers:
$11.75
$17.42
$15.86
$20.18
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 80202 | $13.53 | 1174576698 - CHCA BAYSHORE LP, BAYSHORE MEDICAL CENTER | 621801359 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $16.25 | 1689650921 - EASTLAND MEMORIAL HOSPITAL DISTRICT, EASTLAND MEMORIAL HOSPITAL | 752313255 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $19.78 | 1801825005 - HOSPITAL SERVICE DISTRICT #2 OF LASALLE PARISH, LASALLE GENERAL HOSPITAL | 720690217 - (LA) HOSPITAL SERVICE DISTRICT 2 OF LASALLE PARISH | LA | General Acute Care Hospital (282N00000X) |
United | 80202 | $7.76 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1811942238 - KPH-CONSOLIDATION, INC., HCA HOUSTON HEALTHCARE NORTH CYPRESS A CAMPUS OF HCA HOUSTON HEALTHCAR | 621619857 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $7.94 | 1699768705 - GONZALES HEALTHCARE SYSTEMS | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $7.01 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752796815 - CHRISTUS HEALTH ARK-LA-TEX | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $7.94 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1689628984 - COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP, MEDICAL CITY DALLAS | 621682198 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1871911016 - NORTH TEXAS, MEDICAL CITY ALLIANCE | 464027347 - (TX) NORTH TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1295723229 - ST FRANCIS MEDICAL CENTER, INC | 720408970 - (LA) ST FRANCIS MEDICAL CENTER INC | LA | General Acute Care Hospital (282N00000X) |
United | 80202 | $11.35 | 1871599829 - WILSON COUNTY MEMORIAL HOSPITAL DISTRICT | 742019736 - (TX) WILSON COUNTY MEMORIAL HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1669732178 - AD HOSPITAL EAST, LLC | 475587037 | TX | General Acute Care Hospital (282N00000X) |
United | 80202 | $12.18 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 80202 | $13.53 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 80202 vs. Other Pathology and Laboratory Procedures Codes
The CPT 80202 code is part of the Therapeutic Drug Assays services used for Pathology and Laboratory Procedures. 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 80202 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 |
|---|---|---|
| 80184-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. |
| 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. |
| 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. |
| 80202-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 80202. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80202 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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