Summary & Overview
CPT 80167: Felbamate Quantitative Serum Assay
CPT code 80167 denotes a laboratory test that quantifies felbamate concentrations in patient specimens, typically serum. This assay is clinically important for therapeutic drug monitoring of felbamate, an anticonvulsant used in certain seizure disorders, to guide dosing, assess adherence, and identify toxic levels. As a billed laboratory technical service, CPT code 80167 is relevant to hospital and independent clinical laboratories and to clinicians managing antiepileptic therapy.
Key national payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for felbamate monitoring, common service settings, and the payers commonly involved in coverage and reimbursement for laboratory drug quantification. The publication outlines typical billing considerations for the technical laboratory component and highlights benchmarking and policy topics readers can expect to explore, including national payment patterns, coverage nuances among major payers, and coding relationships to other laboratory and clinical services.
The content provides a concise reference for health system billers, laboratory managers, and clinical stakeholders seeking clarity on the role and classification of CPT code 80167 within therapeutic drug monitoring workflows.
Billing Code Overview
CPT code 80167 describes a laboratory quantitative assay for felbamate, an anticonvulsant medication. The code covers the technical component of testing where a lab analyst performs the analytical procedure to measure the level of felbamate in a patient specimen such as serum.
Service type: Laboratory diagnostic testing (drug quantification)
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with refractory epilepsy stabilized on felbamate therapy presents for routine therapeutic drug monitoring and safety surveillance. The ordering neurologist requests a serum felbamate level to ensure therapeutic concentration while minimizing toxicity. The patient attends an outpatient phlebotomy clinic at a hospital-based laboratory; a blood specimen is collected, processed, and sent to the clinical chemistry lab. The laboratory analyst performs 80167 to quantify serum felbamate concentration using validated analytical methods (e.g., high-performance liquid chromatography or mass spectrometry). Results are reported to the ordering provider and integrated into the patient’s electronic medical record for dosing decisions, adverse effect assessment, and documentation of therapeutic drug monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or oversight portion if applicable in a split billing arrangement. |
59 | Data not provided in the input. |