Summary & Overview
CPT 80192: Procainamide and Metabolite Quantitation
CPT code 80192 represents a laboratory assay to quantitate procainamide and its metabolites in patient specimens. This test supports therapeutic drug monitoring for patients receiving procainamide for cardiac arrhythmias and informs clinical decisions about dosing and toxicity management. Nationally, such drug-level testing matters for patient safety, medication optimization, and coordination between clinicians and laboratory services.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and payment rates for specialty drug assays can vary by payer and by site of service, affecting access and billing practices for hospitals, reference laboratories, and outpatient clinics.
Readers will find clinical context on why procainamide level measurement is performed, an overview of typical settings where the service is provided, and what to expect in payer coverage discussions. The publication also summarizes common billing considerations, including service classification as a clinical laboratory test and typical claim-line attributes. Data not available in the input: payer-specific reimbursement rates, associated taxonomies, ICD-10 diagnoses, and related CPT/HCPCS codes.
Billing Code Overview
CPT code 80192 describes a laboratory quantitative assay for procainamide and its metabolites. The service involves analyzing a patient specimen to determine the concentration of procainamide, an antiarrhythmic medication, and its breakdown products produced by the liver.
Service type: Clinical laboratory therapeutic drug monitoring (to quantitate procainamide and metabolites)
Typical site of service: Clinical laboratory or hospital laboratory (specimens collected in outpatient clinics, hospitals, or ambulatory settings and processed in a lab)
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of atrial fibrillation is managed on procainamide and presents for routine therapeutic drug monitoring after a dose change and new onset of dizziness. A blood specimen is collected in the outpatient laboratory or hospital phlebotomy service and sent to the clinical chemistry/toxicology laboratory. The lab analyst performs the quantitative assay to measure procainamide and its active metabolite N-acetylprocainamide to assess therapeutic level, toxicity risk, and medication adherence. Results are reported to the ordering cardiologist or hospitalist; if levels are supratherapeutic or consistent with toxicity, the clinician adjusts dosing or discontinues the drug and evaluates for proarrhythmia and other adverse effects. Typical sites of service include hospital inpatient labs, outpatient hospital-based laboratories, independent clinical laboratories, and ambulatory clinic phlebotomy services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if applicable (rare for quantitative lab assays where professional interpretation is not reported separately). |
TC | Technical component |