Summary & Overview
CPT 80204: Methotrexate Quantitative Assay, Technical Component
CPT code 80204 represents a laboratory service that quantifies methotrexate levels in patient specimens, typically serum. Methotrexate is an antimetabolite used in oncology and certain autoimmune conditions; monitoring levels guides toxicity management and dose adjustments. Nationally, accurate laboratory measurement of methotrexate is clinically important for patient safety and care coordination across inpatient and outpatient settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage and billing patterns across major commercial and federal payers to provide a broad national perspective.
Readers will find an overview of the clinical context for methotrexate level testing, typical sites of service, and the technical nature of this laboratory procedure. The publication summarizes benchmarks and common payer considerations, outlines relevant modifiers and billing practices provided in the input, and highlights areas where national policy updates or payer-specific coverage rules may affect claim adjudication. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 80204 describes a laboratory assay to quantify methotrexate in a patient specimen, such as serum. The service involves a laboratory analyst performing the technical component of a quantitative drug level test for methotrexate, an antimetabolite medication used to treat conditions with rapid cell proliferation, including certain neoplasms.
-
Service type: Clinical laboratory quantitative drug assay (technical component)
-
Typical site of service: Hospital laboratory, independent clinical laboratory, or outpatient laboratory drawing and analysis setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient receiving high-dose methotrexate for osteosarcoma is admitted for scheduled chemotherapy monitoring. The oncology team orders serum therapeutic drug monitoring (TDM) to quantify methotrexate concentration at specified post-infusion intervals to guide leucovorin rescue and hydration adjustments. A phlebotomist collects the blood specimen and sends it to the hospital clinical chemistry laboratory. The lab analyst performs 80204 using validated immunoassay or chromatographic methods to quantify methotrexate in serum. Results are reported to the oncology team, who interpret levels relative to time-since-dose and renal function to determine continued rescue therapy and discharge timing. Typical site of service is a hospital outpatient infusion center, inpatient hospital laboratory, or independent clinical laboratory supporting oncology services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting the professional interpretation and consultation by a pathologist or laboratory director separate from the technical testing. |
TC | Technical component |