CPT 80365 Oxycodone Assay Reimbursement

CPT code 80365 represents a lab-based assay to detect or measure oxycodone in a patient specimen. As oxycodone is a commonly prescribed synthetic opioid, assays that identify its presence or quantify levels support clinical decisions about pain management, opioid stewardship, and toxicology evaluation. Nationally, utilization of targeted opioid assays factors into outpatient and inpatient management of pain, pre-procedural screening, and suspected overdose or misuse assessments.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and typical sites of service, plus benchmarking context where available. The publication outlines common modifiers and payer coverage patterns, notes clinical scenarios where the assay is applied, and highlights coding relationships relevant to laboratory billing workflows.

This summary provides practical context for revenue cycle, laboratory management, and clinical teams seeking to understand how CPT code 80365 is used in practice, what payers commonly cover, and where this test fits within toxicology and therapeutic drug monitoring services. Data not available in the input.

Billing Code Overview

CPT code 80365 describes a laboratory assay in which the analyst measures the amount of or detects the presence of oxycodone, a synthetic opioid pain medication, in a patient specimen. This service is a toxicology/therapeutic drug monitoring assay focused specifically on oxycodone detection and quantification.

Service Type: Laboratory diagnostic test — drug of abuse/toxicology assay

Typical Site of Service: Clinical laboratory or hospital laboratory

Clinical Context

A typical patient scenario involves a clinician ordering a urine or blood toxicology test to detect and/or quantify oxycodone in a patient who is receiving opioid therapy, presents with suspected overdose, reports inadequate pain control, or is being monitored for compliance in a controlled-substance agreement. The specimen is collected in an outpatient clinic, emergency department, inpatient hospital, or an independent clinical laboratory. The specimen is routed to the laboratory where a technologist performs an analytical assay (e.g., immunoassay screening followed by confirmatory testing such as gas chromatography–mass spectrometry or liquid chromatography–tandem mass spectrometry) to detect the presence and/or measure the concentration of oxycodone. Results are reported to the ordering provider and incorporated into the patient’s medical record to inform clinical decisions about analgesic management, safety, or diversion concerns.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of laboratory testing separate from the technical component.
`90`	Reference (outside) laboratory	Use when the testing is performed by an outside/reference laboratory and billed by the ordering lab/provider.

Taxonomy Code	Specialty	Notes
207Q00000X	Anatomic and Clinical Pathology	Pathologists oversee laboratory testing, interpretation, and result validation.
207L00000X	Clinical Laboratory	Clinical laboratory scientists and directors manage testing operations and quality control.
208600000X	Emergency Medicine	Emergency physicians commonly order oxycodone testing for suspected overdose or opioid-related emergencies.
207R00000X	Pain Medicine	Pain medicine specialists order monitoring tests to manage long-term opioid therapy.
207K00000X	Addiction Medicine	Addiction specialists use oxycodone testing as part of substance-use monitoring and treatment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R78.89`	Other specified abnormal findings of blood chemistry	General code for abnormal drug levels found during toxicology testing.
`T40.2X1A`	Poisoning by other opioids, accidental (unintentional), initial encounter	Applied when oxycodone detection confirms opioid poisoning in an emergency context.
`F11.10`	Opioid abuse, uncomplicated	Used when oxycodone testing supports diagnosis and monitoring of opioid misuse.
`F11.20`	Opioid dependence, uncomplicated	Used when testing is part of monitoring for opioid dependence treatment or compliance.
`Z79.899`	Other long term (current) drug therapy	Used for patients on long-term opioid therapy where periodic oxycodone level monitoring is required.
`Z51.81`	Encounter for therapeutic drug level monitoring	Used when testing is performed specifically for therapeutic drug monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80307`	Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges), each procedure	Commonly used as an initial point-of-care or laboratory screening test prior to specific oxycodone quantitation or confirmation.
`80100`	Drug assay, any number of drug classes; qualitative or semi-quantitative, each procedure	Represents qualitative screening assays that may precede quantitative `80365` measurement.
`80306`	Drug test(s), presumptive, any number of drug classes; multiple drug classes by instrumented chemistry analyzers	Instrumented presumptive testing often used in the same workflow before definitive quantification of oxycodone.
`85025`	Blood count; complete CBC with automated differential WBC count	Frequently ordered concurrently in emergency or inpatient settings when assessing overdose or systemic effects.
`82542`	Assay of digoxin; immunoassay	Example of therapeutic drug monitoring CPTs; conceptually similar laboratory workflows for quantitative assays.
`80366`	Drug assay, quantitative; methadone	Other specific quantitative opioid assays that may be ordered in the same panel or laboratory inventory; represents parallel testing for different opioids.

OpenPayer

Summary & Overview

CPT 80365: Oxycodone Detection and Quantification Assay