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See a sample rate comparisonCPT 80363 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.
Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Therapeutic Drug Assays |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | 90 - Reference Laboratory TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80363 |
| Medicaid Fee Schedule | $16.05 median of the 5 states in the free preview · View Medicaid rates for 80363 |
National average reimbursement for CPT 80363 by major payers:
$34.33
$35.43
$4.01
$62.67
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CPT 80363
5 of 25 sample ratesHigher to lower in this preview
Hospital Service District #2 Of Lasalle Parish, Lasalle General Hospital
Hospital Service District 2 Of Lasalle Parish
$21.23Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$21.23Published ratePiedmont Athens Regional Medical Center, Inc.
Piedmont Athens Regional Medical Center Inc
$19.12Published rateChildren'S Hospital
Childrens Hospital Inc
$19.12Published rateBienville Medical Center, Inc.
$8.92Published rate
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See a sample payer proposalCPT 80363 vs. Other Therapeutic Drug Assays Codes
The CPT 80363 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 80363 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 |
|---|---|---|
| 80346-CPT | Low | Sedative Therapy Monitoring, Benzodiazepines Are A Class Of Sedatives That Can Have Strong Effects. A Blood Analysis Helps To Determine A Therapeutic Dose And Can Show Other Issues Such As Overdosing. |
| 80362-CPT | Low | Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples. |
| 80363-CPT | Low | Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples. |
| 80364-CPT | Low | Opiate Drug Screening, This Test Measures The Amount Of Opiates (Narcotic Painkillers Such As Morphine Or Codeine) Present In Blood And Urine Samples. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 80363. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80363 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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