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See a sample rate comparisonCPT 80280 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.
Vedolizumab, A Lab Test For Vedolizumab. This Drug Is Generally Used To Treat Ulcerative Colitis And Crohns Disease.
| 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 | $38.57 national lab fee schedule rate (2026) · View Medicare rates for 80280 |
| Medicaid Fee Schedule | $35.485 median of the 8 states in the free preview · View Medicaid rates for 80280 |
National average reimbursement for CPT 80280 by major payers:
$30.65
$23.09
$39.55
$75.49
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CPT 80280
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$84.85Published rateChristopher Raio
St Joseph Hospital
$45.82Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$28.44Published rateWilliam Yang
Renal Consultants Medical Group
$16.20Published 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
$13.50Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 80280 vs. Other Therapeutic Drug Assays Codes
The CPT 80280 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 80280 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 80280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80280 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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