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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 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 80369 |
| Medicaid Fee Schedule | $18.28 median of the 6 states in the free preview · View Medicaid rates for 80369 |
National average reimbursement for CPT 80369 by major payers:

$22.29

$15.01

$2.48

$50.86
Choose a payer to see a sample of rates for CPT 80369.
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
Baycare Home Care, Inc.
Baycare Home Care Inc
George Hemstreet
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
Rolando Henriquez
Progressive Medical Center, S.C.
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 80369 vs. Other Therapeutic Drug Assays Codes
The CPT 80369 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 80369 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 |
|---|---|---|
| 80368-CPT | Low | Sedative Drug Screening, This Test Measures The Amount Of Sedative Drugs Present In Blood And Urine Samples. |
| 80369-CPT | Low | Screening For Muscle Relaxants, This Test Measures The Amount Of Muscle Relaxants Present In Blood And Urine Samples. |
| 80370-CPT | Low | Screening For Muscle Relaxants, This Test Measures The Amount Of Muscle Relaxants Present In Blood And Urine Samples. |
| 80371-CPT | Low | Stimulant Drug Screening, This Test Measures The Amount Of Stimulant 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 80369. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 80369 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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