Summary & Overview
CPT 80187: Posaconazole Level Quantification
CPT code 80187 designates the laboratory test that quantitatively measures posaconazole levels in patient specimens. Therapeutic drug monitoring of posaconazole is clinically important for optimizing antifungal therapy in immunocompromised patients at risk for invasive Aspergillus and Candida infections and for managing oropharyngeal candidiasis when drug exposure variability or drug interactions are concerns. Nationally, this code represents a specialized clinical laboratory service that supports patient safety and targeted antifungal dosing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for posaconazole monitoring, typical service settings, and which stakeholders commonly cover or reimburse this testing. The publication also summarizes benchmarks relevant to utilization and payment policies, highlights recent policy considerations affecting laboratory drug monitoring, and outlines practical billing context for providers and labs using CPT code 80187.
This summary targets a national audience of laboratory managers, hospital administrators, clinicians ordering therapeutic drug monitoring, and billing professionals seeking guidance on coding and service expectations for posaconazole quantification.
Billing Code Overview
CPT code 80187 describes a laboratory service in which a lab analyst performs the technical assay to quantify the level of posaconazole in a patient specimen. Posaconazole is an antifungal medication commonly used in immunocompromised patients to prevent or treat invasive Aspergillus and Candida infections and to treat oropharyngeal candidiasis.
Service Type: Therapeutic drug monitoring / antifungal drug level quantification
Typical Site of Service: Clinical laboratory or hospital laboratory where specialized antifungal drug assays are performed. If testing is ordered as part of inpatient care, the service is typically provided by the hospital's laboratory; for outpatient monitoring it is performed by clinical reference laboratories.
Clinical & Coding Specifications
Clinical Context
A 48-year-old immunocompromised patient with acute myeloid leukemia receiving chemotherapy is prescribed oral posaconazole for prophylaxis against invasive Aspergillus and Candida infections. The outpatient oncology clinic orders therapeutic drug monitoring to quantify trough posaconazole levels after the patient has been on therapy for 5–7 days or when there is concern for subtherapeutic exposure due to drug interactions, malabsorption, severe diarrhea, or altered hepatic function. A phlebotomy draw is performed at the clinic or a hospital laboratory; the specimen is processed and sent to the clinical laboratory. The lab analyst performs the technical test using validated assays (e.g., liquid chromatography–tandem mass spectrometry) to quantify posaconazole concentration in the patient specimen. Results are reported back to the prescribing clinician to interpret in the context of dosing, adherence, potential toxicity, and concurrent medications such as proton-pump inhibitors or CYP3A4 modulators. Typical sites of service include hospital clinical laboratories, outpatient hospital laboratories, ambulatory infusion centers, and independent reference laboratories that receive specimens by courier.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the interpreting professional portion of a split technical/professional lab service if applicable |