CPT 80320 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 | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80320 |
| Medicaid Fee Schedule | View Medicaid rates for 80320 |
National average reimbursement for CPT 80320 by major payers:
$17.55
$12.83
$1.84
$46.15
CPT 80320 vs. Other Therapeutic Drug Assays Codes
The CPT 80320 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 80320 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 |
|---|---|---|
| 80305-CPT | Low | Drug Test Prsmv Dir Opt Obs, 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 |
| 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) |
| 80307-CPT | Low | Drug Test Prsmv Chem Anlyzr, Drug Test S Presumptive Any Number Of Drug Classes Any Number Of Devices Or Procedures By Instrument Chemistry Analyzers Eg Utilizing Immunoassay Eg Eia Elisa Emit Fpia Ia Kims Ria Chromatography Eg Gc Hplc And Mass Spectrometry Either With Or Without Chromatography Eg Dart Desi Gc Ms Gc Ms Ms Lc Ms Lc Ms Ms Ldtd Maldi Tof Includes Sample Validation When Performed Per Date Of Service |
| 80320-CPT | Low | Pathology And Laboratory, Drug Screen Quantitative Alcohols |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80320. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80320 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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