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See a sample rate comparisonCPT 80235 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.
Lacosamide, A Lab Test For Lacosamide. This Drug Is Used Primarily To Treat Seizures In Combination 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 | $27.11 national lab fee schedule rate (2026) · View Medicare rates for 80235 |
| Medicaid Fee Schedule | $24.94 median of the 8 states in the free preview · View Medicaid rates for 80235 |
National average reimbursement for CPT 80235 by major payers:
$21.11
$16.31
$27.46
$59.22
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CPT 80235
5 of 25 sample ratesHigher to lower in this preview
Jason Schomburg
Neuroscience Group Of Northeast Wisconsin, S.C.
$66.77Published rateAlison Martin
Neuroscience Group Of Northeast Wisconsin, S.C.
$66.77Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$59.64Published ratePrisma Health-Upstate, Prisma Health Op Surgery Patewood
Prisma Health - Upstate
$24.39Published rateChristus Spohn Health System Corporation, Christus Spohn Hospital Kleberg
C H Wilkinson Physician Network
$11.39Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80235 vs. Other Therapeutic Drug Assays Codes
The CPT 80235 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 80235 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 |
|---|---|---|
| 80220-CPT | Low | Hydroxychloroquine Monitoring, Lab Test That Measures The Therapeutic Level Of Hydroxychloroquine A Medication Used To Treat Malaria Lupus And Rheumatoid Arthritis. |
| 80230-CPT | Low | Infliximab, A Lab Test For Infliximab. This Drug Is Typically Used To Treat Autoimmune Disorders Including Rheumatoid Arthritis And Inflammatory Bowel Disease. |
| 80235-CPT | Low | Lacosamide, A Lab Test For Lacosamide. This Drug Is Used Primarily To Treat Seizures In Combination With Other Drugs. |
| 80280-CPT | Low | Vedolizumab, A Lab Test For Vedolizumab. This Drug Is Generally Used To Treat Ulcerative Colitis And Crohns Disease. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80235 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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