Summary & Overview
CPT 80162: Total Digoxin Measurement, Therapeutic Drug Monitoring
CPT code 80162 denotes a quantitative laboratory assay measuring total digoxin concentration in blood. This test supports clinical management of patients receiving digoxin for congestive heart failure or rate control, helping clinicians identify therapeutic levels and potential toxicity. Nationally, therapeutic drug monitoring codes like 80162 are important for patient safety, medication optimization, and lab reimbursement pathways.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for digoxin monitoring, common sites where the service is performed, and which payers typically cover such laboratory services. The publication also summarizes benchmark elements relevant to lab billing and reimbursement, highlights coding and billing considerations tied to quantitative drug assays, and outlines implications for clinical workflows and laboratory operations.
This summary is designed for clinicians, laboratory managers, and billing professionals seeking a concise national perspective on CPT code 80162, including clinical rationale, payer scope, and what to expect in terms of service delivery and documentation requirements. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 80162 reports a laboratory measurement of total digoxin concentration in a patient's blood. Digoxin is a cardiac glycoside used to treat congestive heart failure and to control heart rate in certain arrhythmias. The assay quantifies the circulating drug level to guide clinical interpretation of therapeutic, subtherapeutic, or toxic concentrations.
Service type: Therapeutic drug monitoring / quantitative laboratory test
Typical site of service: Clinical laboratory or hospital outpatient laboratory where blood specimens are collected and analyzed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with congestive heart failure or atrial fibrillation who is prescribed digoxin for rate control or symptom management. The clinician orders a serum digoxin level to assess therapeutic concentration or suspected toxicity. The patient presents to an outpatient laboratory or hospital phlebotomy service; a venous blood specimen is drawn and sent to the clinical chemistry laboratory. The lab analyst performs quantitative measurement of total digoxin in serum using an immunoassay or mass spectrometry platform, documents results in the electronic medical record, and the ordering provider reviews the level in the context of renal function, electrolytes, concomitant medications, and clinical status to guide dosing or investigate toxicity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician or professional interpretation component if separated from the technical lab component. |
TC | Technical component | Use when reporting only the technical component (laboratory analysis) performed by the facility. |