CPT 80342 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 | • 81 - Independent Laboratory • 11 - Office |
| Common Modifiers | • None • 90 - Reference (Outside) Laboratory • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 80342 by major payers:
$25.35
$14.94
$2.03
$49.25
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 80342 vs. Other Therapeutic Drug Assays Codes
The CPT 80342 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 80342 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 |
|---|---|---|
| 80337 | Low | Definitive Drug Testing; Antidepressants, Tricyclic And Other Cyclicals; 6 Or More |
| 80342 | Low | Definitive Drug Testing; Antipsychotics, Not Otherwise Specified; 1-3 |
| 80343 | Low | Definitive Drug Testing; Antipsychotics, Not Otherwise Specified; 4-6 |
| 80344 | Low | Definitive Drug Testing; Antipsychotics, Not Otherwise Specified; 7 Or More |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80342. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80342 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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