Summary & Overview
CPT 80193: Teriflunamide (Leflunomide) Level Assay
CPT code 80193 covers a laboratory test that quantifies the active metabolite of leflunomide (teriflunamide) in patient specimens. This assay supports therapeutic drug monitoring for adult patients treated with leflunomide, a disease–modifying antirheumatic drug (DMARD) commonly used in rheumatoid arthritis management. Nationally, such specialized drug-level testing informs medication safety, adherence assessment, and dose optimization across outpatient and inpatient care settings.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for ordering the test, typical sites of service, and which payers commonly cover specialized therapeutic drug monitoring. The publication outlines benchmarks for utilization and payment where available, highlights relevant policy or coding updates affecting laboratory services, and explains clinical implications for rheumatology care teams and laboratory operations.
The report is written for a national audience and focuses on what the code represents, who covers the service, and what stakeholders can expect regarding clinical purpose, sites of service, and the types of insights included in the full analysis. Data not provided in the input (such as associated taxonomies, ICD-10 mappings, related codes, and specific utilization metrics) are noted as unavailable in the detailed sections.
Billing Code Overview
CPT code 80193 describes a laboratory assay to quantify the active metabolite of leflunomide (teriflunamide) in a patient specimen. The service entails a laboratory analyst performing the technical testing procedures required to measure teriflunamide levels, which aids in therapeutic drug monitoring for adults receiving leflunomide, a disease–modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis.
Service Type: Therapeutic drug monitoring laboratory test
Typical Site of Service: Clinical laboratory or hospital laboratory (outpatient or inpatient specimen processing)
Clinical & Coding Specifications
Clinical Context
A 56-year-old adult patient with established rheumatoid arthritis (RA) is receiving leflunomide as a disease‑modifying antirheumatic drug (DMARD). The treating rheumatologist orders a therapeutic drug monitoring assay to quantify the active metabolite teriflunomide to assess medication adherence, evaluate subtherapeutic or supratherapeutic exposure, or investigate suspected toxicity (for example, unexplained hepatotoxicity or persistent symptoms despite therapy). A blood specimen is collected at the ambulatory phlebotomy station or hospital laboratory, labeled, and transported to the clinical chemistry or specialty pharmacology laboratory. The laboratory analyst performs the technical wet‑lab testing and quantification of teriflunomide levels using validated methods (for example, liquid chromatography–tandem mass spectrometry). The laboratory issues a technical report with measured concentration and reference intervals to the ordering provider; the rheumatologist integrates the result into clinical management decisions, such as dose adjustment, drug holiday, or alternate DMARD selection. Typical site of service: outpatient hospital laboratory, independent reference laboratory, or hospital inpatient laboratory when monitoring therapy in admitted patients.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard use when no other modifier applies |