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See a sample rate comparisonCPT 80203 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, Zonisamide 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | 90 - Reference Laboratory 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.25 national lab fee schedule rate (2026) · View Medicare rates for 80203 |
| Medicaid Fee Schedule | $13.085 median of the 8 states in the free preview · View Medicaid rates for 80203 |
National average reimbursement for CPT 80203 by major payers:
$11.81
$9.60
$15.23
$41.22
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CPT 80203
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$29.15Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$18.16Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$13.40Published rateCatherine Lee
Columbus Arthritis Center
$10.85Published rateAaron Askew
The Orthopedic And Neurosurgical Center Of The Cascades
$5.57Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80203 vs. Other Therapeutic Drug Assays Codes
The CPT 80203 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 80203 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. |
| 80185-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. |
| 80197-CPT | Low | Immune Suppressant Monitoring, Monitoring Of An Immune Suppressant Drug To Help Prevent Transplant Rejection. |
| 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 80203. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80203 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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