Summary & Overview
CPT 80180: Mycophenolic Acid Level Testing
CPT code 80180 denotes a laboratory assay to determine mycophenolic acid levels in patient specimens. Therapeutic drug monitoring for mycophenolate helps guide dosing for patients on immunosuppressive therapy, with implications for transplant outcomes and management of autoimmune disease. Nationally, accurate reporting of this code supports clinical decision-making, laboratory quality measurement, and payer coverage determinations for specialized pharmacokinetic testing.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for mycophenolic acid monitoring, how the test is billed using CPT code 80180, typical sites of service, and commonly applied modifiers where available. The publication also summarizes benchmarking and policy-relevant considerations for lab-based therapeutic drug monitoring, and notes where input data were not provided.
Billing Code Overview
CPT code 80180 describes a laboratory test that measures the level of mycophenolic acid in a patient's specimen. This test is used to assess systemic exposure to mycophenolate, a medication commonly used for immunosuppression in transplant recipients and certain autoimmune conditions.
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Service type: Therapeutic drug monitoring laboratory assay
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Typical site of service: Clinical laboratory or hospital laboratory performing targeted drug level testing
Clinical & Coding Specifications
Clinical Context
A 45-year-old kidney transplant recipient attends a transplant clinic for routine therapeutic drug monitoring. The patient is on mycophenolate mofetil as part of an immunosuppressive regimen to prevent allograft rejection. The transplant nurse collects a timed blood specimen (often trough or specified post-dose level) and sends it to the clinical laboratory. The laboratory performs quantitative measurement of mycophenolic acid concentration in plasma using validated methods (for example, LC-MS/MS or immunoassay). Results are reported to the transplant nephrologist or transplant pharmacist, who reviews levels in the context of concurrent medications, renal function, signs of rejection or infection, and adjusts the mycophenolate dose if necessary. Billing for the laboratory analysis uses 80180 to report the test that determines the level of mycophenolic acid.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional interpretation component of a related lab service is reported separately by a physician or qualified provider. |
TC | Technical component |