Summary & Overview
CPT 80210: Rufinamide Quantitative Assay
CPT code 80210 represents a laboratory assay that quantifies rufinamide levels in patient specimens, used for therapeutic drug monitoring of this anticonvulsant. Nationally, accurate measurement of antiepileptic drug concentrations supports dose optimization, safety monitoring, and adherence assessment, making this code relevant for outpatient and inpatient laboratory services. The code is typically processed by clinical and hospital laboratories.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 80210 denotes, typical sites of service, and why monitoring rufinamide matters in clinical care. The publication outlines expected service context and payer relevance and highlights available benchmarks and policy considerations where present.
The report provides context on clinical applications of rufinamide measurement, common billing considerations, and where national payer coverage frequently applies. Data not available in the input is noted explicitly for missing elements such as associated taxonomies, specific ICD-10 diagnoses, and detailed payer policy language. This summary serves as a national reference for clinicians, laboratory managers, and billing professionals seeking a clear description of CPT code 80210 and its clinical role.
Billing Code Overview
CPT code 80210 describes a laboratory test in which a lab analyst performs the technical assay to quantify the concentration of rufinamide in a patient specimen (for example, serum). This service is a therapeutic drug monitoring assay for the anticonvulsant medication rufinamide.
Service type: Clinical laboratory quantitative assay (therapeutic drug monitoring)
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient with epilepsy or seizure disorder who is prescribed rufinamide for seizure control. The physician orders a serum rufinamide concentration to assess therapeutic levels, evaluate adherence, investigate subtherapeutic response or toxicity, or guide dose adjustments. The clinical workflow: the outpatient neurology clinic or inpatient neurology team documents the indication and places an order for a rufinamide level; a phlebotomist draws serum or plasma; the specimen is delivered to the clinical laboratory; a laboratory analyst performs the quantitative assay using validated methods (e.g., liquid chromatography–mass spectrometry) and reports the result to the ordering clinician. Typical sites of service include hospital laboratories, independent clinical laboratories, outpatient phlebotomy centers, and inpatient acute care settings. Results are used by neurology, pediatric neurology, emergency medicine, and clinical pharmacology teams to interpret therapeutic exposure and inform dosing decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient services | Use when billing represents the physician or clinic's default professional service context for the encounter ordering the test |
22 |