CPT 80285 Voriconazole TDM Reimbursement

CPT code 80285 represents a clinical laboratory assay for quantifying voriconazole levels in patient specimens. Voriconazole therapeutic drug monitoring informs dosing and safety for patients treated for invasive fungal infections such as candidemia and aspergillosis. Nationally, accurate measurement of antifungal levels supports optimized therapy, reduced toxicity, and improved clinical outcomes in high-risk populations.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the test, the typical service setting, and payer relevance. The publication outlines benchmarking considerations, common billing and coding practices associated with this laboratory service, and clinical context for when voriconazole monitoring is used. It also highlights where input data was not available and directs readers to the code definition for operational clarity.

This summary is intended for a national audience of billing professionals, laboratory managers, and clinical leaders who need a clear understanding of what CPT code 80285 covers, where it is performed, and which major payers commonly cover such testing.

Billing Code Overview

CPT code 80285 describes a laboratory therapeutic drug monitoring test that quantifies the level of voriconazole in a patient specimen. The procedure is the technical laboratory analysis performed by the lab analyst to measure voriconazole concentrations, which supports clinical management of serious fungal infections such as candidemia/candidiasis and invasive aspergillosis.

Service type: Clinical laboratory therapeutic drug monitoring
Typical site of service: Hospital laboratory, independent or reference clinical laboratory, or outpatient laboratory facility

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

Clinical Context

A 56-year-old hospitalized patient with hematologic malignancy develops fever and pulmonary infiltrates. The patient is started on voriconazole for suspected invasive aspergillosis. Therapeutic drug monitoring is ordered to measure serum voriconazole concentration to confirm therapeutic levels and avoid toxicity given variable metabolism and potential drug interactions. A blood specimen is collected by nursing and sent to the hospital clinical laboratory. The laboratory analyst performs the quantitative assay, reports the voriconazole level, and the laboratory report is routed to the treating infectious disease physician and the antimicrobial stewardship team for interpretation and dosing adjustment. Typical sites of service include hospital inpatient laboratory, outpatient hospital-based laboratory, or independent reference laboratory supporting outpatient infusion centers or transplant clinics. The service type is a clinical laboratory quantitative drug assay performed by a laboratory technologist or pharmacist-led laboratory service as part of therapeutic drug monitoring.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component separate from the technical lab processing if applicable to the assay report.
`TC`

Taxonomy Code	Specialty	Notes
207RH0000X	Infectious Disease	Physicians ordering and interpreting voriconazole levels for antifungal management.
207L00000X	Clinical Pathology	Pathologists or laboratory directors overseeing assay validation and reporting.
207LP2900X	Pharmacist	Clinical pharmacists involved in therapeutic drug monitoring and dose adjustment.
207KR0401X	Hematology/Oncology	Oncologists managing patients at high risk for invasive fungal infections and ordering levels.
3336C0002X	Transplant Infectious Disease	Specialists managing transplant recipients with invasive fungal infections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B37.7`	Candidemia	Candidemia patients may receive antifungal therapy including voriconazole with levels monitored for efficacy and toxicity.
`B44.0`	Invasive pulmonary aspergillosis	Primary indication for voriconazole; serum levels are monitored to ensure therapeutic exposure.
`B35.3`	Tinea unguium (onychomycosis)	Systemic antifungal therapy may rarely require level monitoring when drug interactions or toxicity risk exists.
`B44.9`	Aspergillosis, unspecified	Voriconazole used for invasive or disseminated aspergillosis; levels assist dosing.
`B48.0`	Systemic mycoses, unspecified	Broad category where voriconazole therapy and monitoring may be indicated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80053`	Comprehensive metabolic panel	Pre- and concomitant metabolic testing (liver enzymes, renal function) performed to assess voriconazole toxicity risk and guide dosing.
`80076`	Hepatic function panel	Assesses liver enzymes prior to or during voriconazole therapy to monitor for hepatotoxicity.
`36415`	Collection of venous blood by venipuncture	Common specimen collection method used when obtaining blood for voriconazole level measurement.
`80307`	Assay for other drugs, e.g., immunosuppressants, quantitative	Other therapeutic drug monitoring assays commonly ordered alongside voriconazole levels for complex patients (phenobarbital, tacrolimus, etc.).
`81025`	Urine drug screen, multiple drug classes	May be performed when evaluating polypharmacy or potential interactions affecting voriconazole levels.

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Summary & Overview

CPT 80285: Voriconazole Therapeutic Drug Monitoring, Laboratory