CPT 80367 Propoxyphene Test Reimbursement

CPT code 80367 represents a laboratory toxicology service for detecting or quantifying propoxyphene, a narcotic analgesic, in patient specimens. Nationally, this code is relevant for clinical toxicology reporting, medication safety monitoring, and forensic or workplace testing where detection of opioid analgesics is required. Use of this code affects billing for laboratory services that identify exposure to propoxyphene and informs clinical decision-making about analgesic use and potential toxicity.

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 context for propoxyphene testing, the typical sites where the service is performed, and common billing considerations. The publication summarizes billing benchmarks and payer coverage patterns where available, explains coding and service-line placement for laboratory toxicology, and highlights policy or reimbursement factors that influence how laboratories and providers submit claims for this test.

The content is intended to equip billing managers, laboratory directors, and compliance staff with the information needed to classify this service correctly, anticipate payer handling, and place the test within laboratory service lines. Data not available in the input is clearly identified in the relevant sections.

Billing Code Overview

CPT code 80367 describes a laboratory test that measures the amount of or detects the presence of propoxyphene, a narcotic analgesic, in a patient specimen. The service is a toxicology/drug monitoring assay performed by a clinical laboratory analyst to identify propoxyphene exposure.

Service type: Laboratory toxicology testing

Typical site of service: Clinical laboratory or hospital laboratory

Clinical Context

A middle-aged outpatient presents to a hospital or independent clinical laboratory for urine or blood toxicology testing requested by the treating clinician to assess recent opioid exposure and to confirm or exclude use of the specific analgesic propoxyphene. The patient may be evaluated for altered mental status in the emergency department, for suspected opioid-related adverse effects in an inpatient ward, or as part of a preoperative or pain-management program requiring medication monitoring. A clinician orders a targeted assay for propoxyphene when the medication history, pill bottle, prescription record, or clinical presentation suggests possible ingestion. The specimen (urine or serum) is collected according to laboratory chain-of-custody and stability protocols, transported to the laboratory, and processed by qualified laboratory personnel. The lab analyst performs a specific qualitative or quantitative assay to detect the presence of propoxyphene (or its metabolites) and documents results in the laboratory information system. Results are reported to the ordering clinician and incorporated into clinical decision-making such as toxicology interpretation, medication reconciliation, or perioperative clearance. Typical sites of service include hospital laboratories, independent clinical diagnostic laboratories, and larger ambulatory or outpatient laboratory collection centers.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / default	Use when no specific modifier applies to the laboratory service.

Taxonomy Code	Specialty	Notes
3356S	Clinical Laboratory	Clinical laboratory directors and analysts performing toxicology testing.
208000000X	Anatomic and Clinical Pathology	Pathologists overseeing laboratory testing and interpretation.
208D00000X	Toxicology Laboratory	Specialty focusing on drug testing and interpretation.
207R00000X	Emergency Medicine	Emergency physicians who order toxicology testing for acute presentations.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T40.2X1A`	Poisoning by other opioids, accidental (unintentional), initial encounter	Propoxyphene exposure can present as opioid poisoning requiring confirmation of the specific agent.
`T40.2X2A`	Poisoning by other opioids, intentional self-harm, initial encounter	Used when testing for propoxyphene in intentional overdose evaluations.
`T40.2X4A`	Poisoning by other opioids, undetermined, initial encounter	Applied when source or intent of opioid exposure is unclear and specific drug identification is needed.
`R41.82`	Altered mental status, unspecified	Patients with altered mental status may undergo targeted toxicology testing including propoxyphene.
`Z51.81`	Encounter for therapeutic drug monitoring	Used when propoxyphene levels are monitored for therapeutic dosing or toxicity risk in pain management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80305`	Drug test(s), presumptive, any number of drug classes; any number of devices or procedures, capable of being read visually (e.g., immunoassay)	Common screening test performed before or alongside a targeted confirmatory assay for specific drugs such as propoxyphene.
`80320`	Drug confirmation, qualitative or quantitative, multiple drug classes by mass spectrometry, each specimen; e.g., gas or liquid chromatography with mass spectrometry (GC-MS or LC-MS)	A confirmatory methodology often used when `80367` (specific propoxyphene assay) requires definitive confirmation or quantitation.
`G0480`	Toxicology testing, definitive, for drugs of abuse, any number of specimens, 1-7 drug classes (Note: G-codes are applicable for certain payers and programs)	May be used for payer-specific billing of definitive toxicology testing in broader panels that include propoxyphene.
`81002`	Urinalysis, non-automated, without microscopy	Specimen evaluation commonly performed at collection to assess specimen integrity and concentration prior to specific drug testing.
`36415`	Collection of venous blood by venipuncture	Commonly performed when serum quantitation of propoxyphene is required instead of urine.

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Summary & Overview

CPT 80367: Propoxyphene Detection in Patient Specimen