Summary & Overview
CPT 80358: Methadone Detection or Quantification
CPT code 80358 represents laboratory analysis to detect or quantify methadone in a patient specimen. This code is used for toxicology screening, therapeutic drug monitoring, and compliance verification in contexts such as medication-assisted treatment and pain management. Nationally, methadone testing is a component of efforts to monitor opioid therapy, prevent diversion, and support substance use disorder treatment programs, making accurate coding important for clinical documentation and payer adjudication.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and typical sites of service for this laboratory procedure, guidance on common billing modifiers and administrative considerations where provided, and direction to related resources. The publication outlines benchmarking and payment context where available, highlights policy or coverage updates that affect laboratory toxicology testing, and situates CPT code 80358 within common laboratory workflows and reporting practices. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
CPT code 80358 describes laboratory testing in which a lab analyst measures the amount of or detects the presence of methadone in a patient specimen. This service involves qualitative or quantitative analysis of methadone levels to support clinical management, toxicology screening, compliance monitoring, or medication-assisted treatment programs.
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Service type: Clinical laboratory testing for therapeutic drug monitoring and toxicology
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Typical site of service: Hospital laboratory, independent clinical laboratory, or outpatient laboratory collection site
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult enrolled in an outpatient addiction treatment program or a pain management clinic who is prescribed methadone for opioid use disorder or chronic pain. The clinician orders a laboratory urine or serum drug test to measure methadone concentration or to confirm presence for monitoring therapeutic compliance, detecting diversion, or assessing potential toxicity. Specimen collection occurs at a clinic or outpatient laboratory; the specimen is sent to a clinical chemistry/toxicology laboratory where a laboratory analyst performs an assay (e.g., immunoassay screening followed by confirmatory chromatographic testing) and documents quantitative or qualitative methadone results in the laboratory information system. Results are reviewed by the treating clinician to guide dosing, counseling, or treatment adjustments. Typical sites of service include hospital outpatient laboratories, independent clinical reference laboratories, and outpatient drug testing facilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no other modifier applies |
22 | Increased procedural services | Unusual effort or complexity in specimen processing or analysis beyond typical workflow |