CPT 80202 Vancomycin Quant Assay Reimbursement | OpenPayer

Summary & Overview

CPT 80202: Vancomycin Quantitative Assay

CPT code 80202 represents a quantitative laboratory assay to measure vancomycin levels in a patient specimen. This therapeutic drug monitoring test is clinically important for optimizing vancomycin dosing, minimizing toxicity, and ensuring efficacy across inpatient and outpatient settings. Nationally, vancomycin monitoring is a routine component of antimicrobial stewardship and hospital lab services, affecting hospital labs, independent clinical laboratories, and payers that cover laboratory diagnostics.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the role of vancomycin quantitation, typical sites of service, and common billing modifiers used with laboratory technical services. The publication also summarizes what to expect in payer coverage considerations, common procedural usage, and areas where more detailed coding or clinical documentation may be required. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare80202CPTvancomycintherapeutic drug monitoringlaboratoryclinical chemistryantibiotic monitoringlab test billing

Billing Code Overview

CPT code 80202 describes a quantitative laboratory assay for vancomycin, where a laboratory analyst performs the technical testing to measure the concentration of the antibiotic in a patient specimen. This service is a therapeutic drug monitoring laboratory test used to guide dosing and assess drug exposure.

Service type: Clinical laboratory drug quantitation (technical component)
Typical site of service: Hospital laboratory, independent clinical laboratory, or outpatient laboratory collection and testing facility

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A hospitalized adult patient receiving intravenous vancomycin for a severe Gram-positive infection (for example, methicillin-resistant Staphylococcus aureus bacteremia or complicated skin and soft tissue infection) requires therapeutic drug monitoring. The clinician orders a quantitative vancomycin serum concentration to guide dosing. A phlebotomy or nursing team draws a timed trough or peak specimen and sends it to the hospital laboratory or a reference lab. The lab analyst performs the technical assay to quantitate vancomycin (CPT 80202), runs required controls and calibration, documents analytic results, and posts the numeric concentration to the laboratory information system. The clinical team reviews the result and adjusts dose or interval to achieve therapeutic levels while minimizing toxicity. Typical site of service is an outpatient or inpatient clinical laboratory within an acute care hospital, long-term acute care facility, or independent diagnostic laboratory with sample transport from clinics, emergency department, or inpatient units.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When only the physician professional component for interpretation or consultation is reported separate from the technical lab work (rare for quantitative drug assays).

CPT 80363: Opioid Panel, 3–4 Analytes

CPT-80164-VALPROIC-ACID-TOTAL-BLOOD-LEVEL

CPT 80164: Total Valproic Acid (Dipropylacetic Acid) Blood Level

CPT-80328-ANABOLIC-STEROID-PANEL-THREE-OR-MORE

CPT 80328: Detection of Three or More Anabolic Steroids

CPT-80376-DRUG-TESTING-PANEL-4-TO-6-SUBSTANCES

CPT 80376: Definitive Drug Panel, Four to Six Substances

CPT-80200-TOBRAMYCIN-QUANTITATIVE-DRUG-ASSAY

CPT 80200: Tobramycin Quantitative Drug Assay

CPT-80329-NONOPIOID-ANALGESIC-DETECTION

CPT 80329: Detection or Measurement of One or Two Nonopioid Analgesics

CPT-80373-TRAMADOL-TOXICOLOGY-ASSAY

CPT 80373: Tramadol Detection/Quantitation in Patient Specimen

CPT-80173-HALOPERIDOL-QUANTITATION-LAB-TEST

CPT 80173: Haloperidol Quantitative Assay, Laboratory Analysis

CPT-80355-GABAPENTIN-NON-BLOOD-DRUG-TESTING

CPT 80355: Gabapentin Testing on Non-Blood Specimens

CPT-80175-LAMOTRIGINE-LEVEL-TESTING-THERAPEUTIC-DRUG-MONITORING

CPT 80175: Lamotrigine Level Measurement

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Pathology	Pathologists oversee clinical chemistry labs and validate results.
`208000000X`	Clinical Laboratory	Clinical laboratory scientists and medical technologists perform and report `CPT 80202`.
`207L00000X`	Infectious Disease	Infectious disease physicians order and interpret vancomycin levels for complex infections.
`207RC0000X`	Hospitalist Medicine	Hospitalists frequently manage inpatient therapeutic drug monitoring and dosing.
`207K00000X`	Nephrology	Nephrologists manage vancomycin dosing in patients with renal impairment and dialysis.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B95.62`	Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere	MRSA bacteremia or deep-seated MRSA infections commonly require vancomycin and monitoring of serum levels.
`A49.02`	Methicillin resistant Staphylococcus aureus infection, unspecified site	MRSA infections treated with vancomycin where levels are monitored for efficacy and toxicity.
`A41.9`	Sepsis, unspecified organism	Severe systemic infections often prompt broad-spectrum antibiotics including vancomycin and require therapeutic monitoring.
`J18.9`	Pneumonia, unspecified organism	Suspected or confirmed severe pneumonia where vancomycin is used for suspected MRSA coverage and serum levels may be checked.
`L03.90`	Cellulitis, unspecified	Complicated skin and soft tissue infections treated with IV vancomycin where trough monitoring guides dosing.
`N17.9`	Acute kidney failure, unspecified	Renal impairment alters vancomycin clearance; levels guide dosing adjustments to avoid toxicity.
`T36.2X5A`	Adverse effect of penicillins, initial encounter	Example of antibiotic adverse reaction context where alternative agents like vancomycin are used and monitored.
`Z51.89`	Encounter for other specified aftercare	Follow-up monitoring visits for therapeutic drug monitoring may be coded using aftercare codes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Performed immediately prior to `CPT 80202` to obtain the serum sample for vancomycin quantitation.
`80305`	Drug test, presumptive, any number drug classes; any number of devices or procedures, qualitative or semi-quantitative, multiple or single drug class(es)	May be performed in initial drug screening workflows but does not replace quantitative vancomycin assay; complementary when broader drug monitoring is required.
`84443`	Assay of thyrotropin (TSH)	Example of another single-analyte quantitative assay performed in the clinical chemistry lab alongside vancomycin levels; indicates typical lab workflow rather than direct clinical relation.
`80053`	Comprehensive metabolic panel; 14 tests	Frequently ordered concurrently to assess renal and hepatic function that affect vancomycin dosing and clearance.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Captures the vancomycin infusion event in outpatient or infusion center settings that precedes therapeutic drug monitoring.

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