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See a sample rate comparisonHealthcare 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 | 90 - Reference Laboratory TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80368 |
| Medicaid Fee Schedule | $15.75 median of the 5 states in the free preview · View Medicaid rates for 80368 |
National average reimbursement for CPT 80368 by major payers:

$20.11

$14.84

$2.32

$52.49
Choose a payer to see a sample of rates for CPT 80368.
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
Baycare Home Care, Inc.
Baycare Home Care Inc
Progressive Emergency Physicians PLLC
Matthew Lilley
The Orthopedic And Neurosurgical Center Of The Cascades
Leon Home Health, LLC, Leon At Home
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 80368 vs. Other Therapeutic Drug Assays Codes
The CPT 80368 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 80368 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. |
| 80350-CPT | Low | Cannabinoid Drug Screening, This Test Measures The Amount Of Cannabinoids Present In Blood And Urine Samples. |
| 80357-CPT | Low | Ketamine Drug Screening, This Test Measures The Amount Of Ketamine Present In Blood And Urine Samples. |
| 80368-CPT | Low | Sedative Drug Screening, This Test Measures The Amount Of Sedative Drugs 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 80368. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80368 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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