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See a sample rate comparisonCPT 80210 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.
Rufinamide Monitoring, This Test Measures The Therapeutic Level Of Rufinamide A Seizure Medication Typically Used To Treat Patients Who Have Lennox-Gastaut Syndrome (Lgs).
| 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 | $27.11 national lab fee schedule rate (2026) · View Medicare rates for 80210 |
| Medicaid Fee Schedule | $24.94 median of the 8 states in the free preview · View Medicaid rates for 80210 |
National average reimbursement for CPT 80210 by major payers:
$21.48
$16.31
$26.93
$58.44
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CPT 80210
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$59.64Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$27.11Published rateCentrastate Medical Center, Inc
Atlantic Health System Inc
$17.62Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$11.39Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$9.48Published rate
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See a sample payer proposalCPT 80210 vs. Other Therapeutic Drug Assays Codes
The CPT 80210 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 80210 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 |
|---|---|---|
| 80189-CPT | Low | Itraconazole Monitoring, This Test Measures The Therapeutic Level Of Itraconazole A Drug That Is Typically Used To Treat A Fungal Infection. |
| 80195-CPT | Low | Sirolimus |
| 80197-CPT | Low | Immune Suppressant Monitoring, Monitoring Of An Immune Suppressant Drug To Help Prevent Transplant Rejection. |
| 80210-CPT | Low | Rufinamide Monitoring, This Test Measures The Therapeutic Level Of Rufinamide A Seizure Medication Typically Used To Treat Patients Who Have Lennox-Gastaut Syndrome (Lgs). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80210. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80210 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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