Summary & Overview
CPT 80198: Theophylline Quantitation Laboratory Test
CPT code 80198 represents the technical laboratory analysis to quantitate theophylline levels in a patient specimen. Theophylline is a bronchodilator used in chronic respiratory conditions; measuring its concentration supports therapeutic drug monitoring to ensure efficacy and avoid toxicity. Nationally, this code matters because therapeutic drug monitoring influences medication safety, dosing decisions, and utilization of laboratory services across outpatient and inpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the test, common sites of service, and the role of this assay in care management. The publication summarizes payer coverage patterns and reimbursement benchmarks where available, highlights coding and billing considerations related to lab technical services, and outlines typical clinical scenarios prompting testing.
This resource is intended to inform billing professionals, laboratory managers, and clinical leaders about the purpose and service context of CPT code 80198, how it fits into therapeutic drug monitoring workflows, and what topics to consider when evaluating coverage and utilization at a national level.
Billing Code Overview
CPT code 80198 describes a laboratory analytical procedure to quantitate theophylline in a patient specimen. The service entails the technical performance of a laboratory test to measure the concentration of theophylline, a prescription medication used to manage certain chronic respiratory conditions.
Service Type: Clinical laboratory test — therapeutic drug monitoring
Typical Site of Service: Clinical laboratory or hospital laboratory (inpatient/outpatient specimen analysis)
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chronic obstructive pulmonary disease (COPD) or asthma who is being monitored for therapeutic drug levels of theophylline. The clinician orders a serum theophylline concentration when a patient presents with symptoms suggesting subtherapeutic dosing (worsening dyspnea, increased rescue inhaler use) or possible toxicity (nausea, vomiting, tachycardia, arrhythmia, neurologic changes). A phlebotomy technician collects a blood specimen in an outpatient laboratory, emergency department, or inpatient hospital setting and sends it to the clinical chemistry laboratory. The lab analyst performs the quantitative assay described by CPT 80198 using appropriate instrumentation (e.g., immunoassay or chromatographic methods), documents results in the laboratory information system, and reports values to the ordering provider. Typical sites of service include hospital laboratories, independent clinical laboratories, and outpatient hospital or clinic labs. Turnaround time and documentation support clinical decisions about dose adjustment, adherence, drug interactions, or need for further monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used (placeholder) | Not typically appended; billing systems may show as default when no other modifier applies. |
| 26 | Professional component | Use when billing only the professional interpretation/component of a test if applicable.