Summary & Overview
CPT 80230: Quantitative Infliximab Level Assay
CPT code 80230 represents a laboratory technical assay to quantify infliximab levels in patient specimens. Therapeutic drug monitoring for biologic agents such as infliximab is important for optimizing treatment of immune‑mediated conditions, guiding dosing decisions, and identifying subtherapeutic exposure or drug clearance. Nationally, this code captures specialized laboratory activity that supports personalized medicine and value‑based care pathways.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for infliximab testing, typical settings where the service is performed, and the types of benchmarks and policy considerations commonly associated with laboratory therapeutic drug monitoring. The publication summarizes service definitions, sites of service, and the payer landscape relevant to coverage and utilization discussions. It also highlights common operational considerations for laboratories performing quantitative infliximab assays.
Data not available in the input for associated taxonomies, ICD‑10 diagnoses, specific coverage policies, and utilization benchmarks are noted where applicable in the full publication.
Billing Code Overview
CPT code 80230 describes a laboratory technical service to quantify infliximab levels in a patient specimen. The procedure measures the concentration of the therapeutic monoclonal antibody infliximab, which targets tumor necrosis factor–alpha (TNF–a) and is used to manage multiple immune‑mediated conditions.
Service type: Therapeutic drug monitoring / quantitative laboratory assay
Typical site of service: Clinical laboratory or hospital laboratory performing specialized immunoassay testing.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 34-year-old with moderate-to-severe Crohn disease receiving maintenance therapy with infliximab. The patient presents for routine therapeutic drug monitoring because of recurrent symptoms of abdominal pain and diarrhea despite scheduled infusions. The clinical workflow: the gastroenterologist orders a serum infliximab concentration test to quantify trough drug level and inform decisions about dose adjustment or switching biologics. A phlebotomy technician collects a blood specimen immediately before the next infusion (trough sample) and sends the specimen to the clinical laboratory. The laboratory analyst performs the technical assay to quantify infliximab concentration (CPT 80230), generates the result and forwards it to the ordering provider. The provider integrates the infliximab level with clinical assessment and, if available, anti-drug antibody results to determine whether to increase dose, shorten interval, or change therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no modifier applies |
26 | Professional component |