Summary & Overview
CPT 80375: Targeted Quantitation of One to Three Definitive Drugs
CPT code 80375 represents a targeted laboratory assay that measures the presence or amount of one to three definitive drugs in a patient specimen (examples include elemental drugs such as gold). This code matters nationally because targeted quantitative toxicology and therapeutic drug monitoring guide clinical management for exposure, toxicity, and therapy monitoring and often influence downstream care decisions and resource use.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for targeted drug quantitation, typical sites of service (clinical and hospital laboratories), common billing modifiers associated with laboratory services, and which payers and program types commonly reimburse these assays. The publication outlines typical use cases for definitive drug testing, operational considerations for laboratorians, and the role of such testing in confirming exposures or monitoring therapy.
This summary provides benchmarks and policy-relevant context rather than patient-level clinical guidance. Data not available in the input for payer-specific rates, associated taxonomies, ICD-10 pairings, and related billing codes are noted as unavailable where applicable.
Billing Code Overview
CPT code 80375 describes a laboratory assay in which a lab analyst measures the presence or amount of one to three definitive drugs (for example, gold) in a patient specimen. This is a toxicology/therapeutic drug monitoring test that quantifies specific drug(s) rather than performing broad screening panels.
Service Type: Definitive drug quantitation / targeted drug analysis
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A patient with suspected heavy metal exposure or monitoring of therapeutic metal levels (for example, gold therapy for rheumatoid arthritis) has a blood or urine specimen collected in an outpatient phlebotomy or hospital laboratory setting. The clinician orders a quantitative assay to measure the presence or concentration of one to up to three definitive metals or definitive drugs in the specimen. The specimen is received by the clinical laboratory, accessioned, and analyzed using an appropriate analytical method (such as atomic absorption, inductively coupled plasma mass spectrometry, or validated immunoassay) to determine the presence or amount of the target analytes. Results are reviewed by a laboratory scientist or pathologist, documented in the laboratory information system, and reported to the ordering provider. Typical sites of service include hospital laboratories, independent reference laboratories, and outpatient clinic laboratories. Typical patient scenarios include monitoring of gold levels in patients receiving gold salt therapy for rheumatoid arthritis, assessment after occupational or environmental exposure to a specific metal, or targeted toxicology testing when clinical history indicates likely exposure to a small number of definitive substances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or report by the pathologist/lab director separate from the technical component. |