CPT 80305 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 | • Pathology and Laboratory Procedures • Therapeutic Drug Assays |
| Common Place of Service | • 11 - Office • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • QW - CLIA Waived Tests • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80305 |
National average reimbursement for CPT 80305 by major payers:
$10.90
$8.11
$13.74
$32.86
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 80305 | ||||||
United | 80305 | $6.28 | 1780696401 - LANI ACKERMAN | 680517887 - (TX) FAMILY HEALTH SPECIALISTS PLLC | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $12.60 | 1225574007 - ELIZABETH ADKISON | 346004382 | TX | Family Nurse Practitioner (363LF0000X) |
United | 80305 | $5.28 | 1013155050 - JAIME RUEDA | 831496764 - (TX) MOUNT CARMEL MEDICAL CLINIC PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 80305 | $6.92 | 1093910697 - SHAUN MCMURTRY | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $6.28 | 1760863153 - CHRISTOPHER VERA | 742867580 - HEART OF TEXAS COMMUNITY HEALTH CENTER INC | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $5.28 | 1952311326 - STEPHEN TSENG | 742805218 - (TX) STEPHEN S. TSENG, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 80305 | $5.28 | 1215297155 - JUAN DAVILA | 881114150 - (TX) HARBOR HEALTH MEDICAL GROUP | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $6.28 | 1497119390 - EMILY SLIZ | 830392136 - (TX) PREVENTATIVE CARE HEALTH SERVICES INC | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $5.28 | 1053900498 - AURORA MUSTAFA ALVAREZ | 863741153 - (TX) MAR SLZ LLC | TX | Family Nurse Practitioner (363LF0000X) |
United | 80305 | $6.28 | 1447323159 - LOWELL ROLLINS | 760314833 - (TX) HUNTSVILLE PEDIATRIC & ADULT MED | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $6.28 | 1982682225 - VICTORIANO VALDEZ | 742682934 - (TX) VICTORIANO VALDEZ MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 80305 | $7.55 | 1861694424 - LONG HOANG | 922483941 - (GA) JOURNEYCARE FAMILY MEDICINE LLC | TX | Family Medicine Physician (207Q00000X) |
United | 80305 | $5.28 | 1073392635 - JENNIFER STRIMPLE | 462456505 - PRIVIA MEDICAL GROUP - GULF COAST | TX | Family Nurse Practitioner (363LF0000X) |
United | 80305 | $5.28 | 1336779941 - KIMBERLY SCOTT | 863556935 - (TX) HEALTHY HAVEN HEALTHCARE | TX | Family Nurse Practitioner (363LF0000X) |
United | 80305 | $5.28 | 1235137662 - ALICE RAMSEY | 475628642 | TX | Family Medicine Physician (207Q00000X) |
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 80305 vs. Other Therapeutic Drug Assays Codes
The CPT 80305 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 80305 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 |
|---|---|---|
| 80285-CPT | Low | Lab & Path - Therap Drug Assay |
| 80299-CPT | Low | Quantitation Of Therapeutic Drug Not Elsewhere Specified (Desc Revised 01/01/15) |
| 80305-CPT | Low | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; Capable Of Being Read By Direct Optical Observation Only (Eg Utilizing Immunoassay [Eg Dipsticks Cups Cards Or Cartridges]) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) |
| 80306-CPT | Low | Drug Test(S) Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures; Read By Instrument Assisted Direct Optical Observation (Eg Utilizing Immunoassay [Eg Dipsticks Cups Cards Or Cartridges]) Includes Sample Validation When Performed Per Date Of Service (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80305. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80305 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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