Summary & Overview
CPT 80183: Oxcarbazepine Level Assay
CPT code 80183 represents a laboratory assay to determine the level of oxcarbazepine in a patient specimen. Therapeutic drug monitoring for antiepileptic agents like oxcarbazepine is clinically important for dose optimization, detecting nonadherence, and identifying toxic concentrations. Nationally, accurate coding for such assays affects lab reimbursement, utilization tracking, and clinical care coordination across inpatient and outpatient settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical purpose and the typical sites of service, plus benchmarking information where available. The publication covers payer coverage landscape, common modifiers associated with lab services, and how CPT code 80183 is used in claims documentation.
This resource provides clinicians, billing staff, and health policy professionals with concise context on what CPT code 80183 denotes, the clinical scenarios that prompt oxcarbazepine testing, and the administrative considerations that influence reimbursement and reporting. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 80183 describes a laboratory test that measures the concentration of oxcarbazepine in a patient specimen. This service is a therapeutic drug monitoring test used to assess medication levels for dosing, adherence, or toxicity evaluation.
Service type: Laboratory diagnostic test
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with focal epilepsy is taking oxcarbazepine for seizure control and presents for routine therapeutic drug monitoring after a recent dose adjustment due to breakthrough partial seizures. The clinician orders a serum level of oxcarbazepine to assess compliance, therapeutic concentration, and to guide further titration. Blood is drawn in an outpatient laboratory or clinic phlebotomy area; the specimen is sent to a clinical chemistry laboratory where quantitative measurement of oxcarbazepine or its active metabolite is performed using validated methods (e.g., high-performance liquid chromatography or mass spectrometry). Results are reported to the treating neurologist or primary care provider, who documents interpretation and any medication changes in the medical record. Typical sites of service include outpatient clinic laboratory draw stations, hospital outpatient laboratories, or independent clinical reference laboratories performing the assay.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
91 | Repeat clinical diagnostic laboratory test | Use when the oxcarbazepine level is repeated on the same day to confirm unexpected result. |
90 | Reference laboratory |